Healthcare Provider Details

I. General information

NPI: 1174735690
Provider Name (Legal Business Name): HEATHER LOUISE SCHUBACK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

4800 SAND POINT WAY NE M/S B-6553 PO BOX 5371
SEATTLE WA
98105-3901
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-2106
  • Fax:
Mailing address:
  • Phone: 206-987-2106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301088432
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number60148265
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: