Provider Demographics
NPI:1992817498
Name:SHAUB, BRIAN MICHAEL (DO)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:MICHAEL
Last Name:SHAUB
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:13110 ELK MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-7182
Mailing Address - Country:US
Mailing Address - Phone:813-349-7568
Mailing Address - Fax:813-349-7568
Practice Address - Street 1:14254 MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:FL
Practice Address - Zip Code:33527-4414
Practice Address - Country:US
Practice Address - Phone:813-349-7700
Practice Address - Fax:813-349-7761
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-01-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS8265207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266531000Medicaid
FL266531000Medicaid
FLH61384Medicare UPIN
FL62170YMedicare PIN