Healthcare Provider Details

I. General information

NPI: 1740218973
Provider Name (Legal Business Name): HARVEY ALLEN SHUB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 12/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 S SEMORAN BLVD STE 6A
ORLANDO FL
32822-1777
US

IV. Provider business mailing address

5425 S SEMORAN BLVD STE 6A
ORLANDO FL
32822-1777
US

V. Phone/Fax

Practice location:
  • Phone: 407-482-0052
  • Fax: 407-482-0198
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number30422
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME30422
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: