Provider Demographics
NPI:1558525618
Name:SHORY, CARL BRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:BRIAN
Last Name:SHORY
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 1:2206 CAHABA VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-2666
Mailing Address - Country:US
Mailing Address - Phone:205-995-2402
Mailing Address - Fax:205-995-4011
Practice Address - Street 1:2206 CAHABA VALLEY DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-2666
Practice Address - Country:US
Practice Address - Phone:205-995-2402
Practice Address - Fax:205-995-4011
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11475208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
C75897Medicare UPIN