Provider Demographics
NPI:1902807456
Name:SHUBERT, EDWARD ELMER (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ELMER
Last Name:SHUBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17070 RED OAK DRIVE
Mailing Address - Street 2:#405
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2616
Mailing Address - Country:US
Mailing Address - Phone:281-440-1500
Mailing Address - Fax:281-440-0052
Practice Address - Street 1:17070 RED OAK DRIVE
Practice Address - Street 2:#405
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2616
Practice Address - Country:US
Practice Address - Phone:281-440-1500
Practice Address - Fax:281-440-0052
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8173207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX032954201Medicaid
B26429Medicare UPIN
TX8F21506Medicare PIN