Healthcare Provider Details

I. General information

NPI: 1942238241
Provider Name (Legal Business Name): PETER J SCHUBART MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 OCONNOR DR SUITE 370
SAN JOSE CA
95128-1633
US

IV. Provider business mailing address

2512 SAMARITAN CT SUITE E
SAN JOSE CA
95124-4002
US

V. Phone/Fax

Practice location:
  • Phone: 408-292-7202
  • Fax: 408-297-2351
Mailing address:
  • Phone: 408-358-8272
  • Fax: 408-356-7779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberG40729
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: