=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164474011
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIC SCHUBERT DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2006
-----------------------------------------------------
Last Update Date | 05/11/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2875 RAVINE WAY
-----------------------------------------------------
City | DUBLIN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43017-3507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-395-3517
-----------------------------------------------------
Fax | 866-244-0657
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5324 SPORTSMAN CLUB RD
-----------------------------------------------------
City | JOHNSTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43031-8147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-395-3517
-----------------------------------------------------
Fax | 866-244-0657
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 36-00-3098-S
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------