MEDICARE: LEONARD WESLEY SCHUBRING PA C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	5601001109	MI
2	363A00000X	Physician Assistant	PA2879	FL

General Provider Information

NPI Number	:	1134114606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONARD WESLEY SCHUBRING PA C

Provider Business Mailing Address
First Line	:	PO BOX 411875
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32941-1875
Country	:	US
Telephone Number	:	321-794-0309
Fax Number	:

Provider Business Practice Location Address
First Line	:	1381 S PATRICK DR
Second Line	:	FAMILY PRACTICE
City	:	PATRICK AFB
State	:	FL
Zip	:	32925-3606
Country	:	US
Telephone Number	:	321-794-0309
Fax Number	:	321-494-8980

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	07/31/2010

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