Provider Demographics
NPI:1477940971
Name:BRUMMETT, SHAWN L (MD)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:L
Last Name:BRUMMETT
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 1:4100 SW I ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-0200
Mailing Address - Country:US
Mailing Address - Phone:479-268-7640
Mailing Address - Fax:479-254-2951
Practice Address - Street 1:4100 SW I ST STE 200
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712
Practice Address - Country:US
Practice Address - Phone:479-268-7640
Practice Address - Fax:479-254-2951
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE10255207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine