Provider Demographics
NPI:1508858739
Name:SHON, BRIAN Y (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:Y
Last Name:SHON
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 1:6567 E CARONDELET DR
Mailing Address - Street 2:#215
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-2156
Mailing Address - Country:US
Mailing Address - Phone:520-722-1087
Mailing Address - Fax:520-722-5887
Practice Address - Street 1:6567 E CARONDELET DR
Practice Address - Street 2:#215
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2156
Practice Address - Country:US
Practice Address - Phone:520-722-1087
Practice Address - Fax:520-722-5887
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11496207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ221854Medicaid
D37644Medicare UPIN
ZWMBQY01Medicare PIN