Healthcare Provider Details

I. General information

NPI: 1801817465
Provider Name (Legal Business Name): RONALD SCHUBERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 10/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 S GRADY WAY STE 600
RENTON WA
98057-3227
US

IV. Provider business mailing address

1811 MARINER CIR NE
TACOMA WA
98422-3470
US

V. Phone/Fax

Practice location:
  • Phone: 206-823-1004
  • Fax: 206-309-3319
Mailing address:
  • Phone: 253-344-9749
  • Fax: 253-927-2627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00038272
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: