Provider Demographics
NPI:1184825283
Name:SHIN, BRION B (MD)
Entity Type:Individual
Prefix:DR
First Name:BRION
Middle Name:B
Last Name:SHIN
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 1:6450 PROVISION CARES WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2544
Mailing Address - Country:US
Mailing Address - Phone:865-862-1600
Mailing Address - Fax:
Practice Address - Street 1:6450 PROVISION CARES WAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2544
Practice Address - Country:US
Practice Address - Phone:865-862-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066928A2085R0001X
CAA943462085R0001X
TN627752085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ069892Medicaid
IN216950BBMedicare PIN