Healthcare Provider Details

I. General information

NPI: 1134114606
Provider Name (Legal Business Name): LEONARD WESLEY SCHUBRING PA C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 07/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1381 S PATRICK DR FAMILY PRACTICE
PATRICK AFB FL
32925-3606
US

IV. Provider business mailing address

PO BOX 411875
MELBOURNE FL
32941-1875
US

V. Phone/Fax

Practice location:
  • Phone: 321-794-0309
  • Fax: 321-494-8980
Mailing address:
  • Phone: 321-794-0309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601001109
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2879
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: