Provider Demographics
NPI:1376530899
Name:SHANER, BRIAN ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ALLEN
Last Name:SHANER
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 1:1821 HILLANDALE RD
Mailing Address - Street 2:SUITE 24B
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2659
Mailing Address - Country:US
Mailing Address - Phone:919-383-5437
Mailing Address - Fax:919-383-7694
Practice Address - Street 1:1901 HILLANDALE RD
Practice Address - Street 2:SUITE B
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-2664
Practice Address - Country:US
Practice Address - Phone:919-383-5437
Practice Address - Fax:919-383-7694
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055766A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine