MEDICARE: BRUCE FRED SCHUBERT PA

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	363AM0700X	Medical Physician Assistant	PA00540	TX

General Provider Information

NPI Number	:	1386614964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE FRED SCHUBERT PA

Provider Business Mailing Address
First Line	:	PO BOX 1208
Second Line	:
City	:	DALHART
State	:	TX
Zip	:	79044
Country	:	US
Telephone Number	:	806-249-8324
Fax Number	:	806-249-8412

Provider Business Practice Location Address
First Line	:	201 TEXAS BLVD
Second Line	:
City	:	DALHART
State	:	TX
Zip	:	79022
Country	:	US
Telephone Number	:	806-249-8324
Fax Number	:	806-249-8412

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

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	03/04/2010

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