Provider Demographics
NPI:1588667414
Name:SHWER, BRIAN IVAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:IVAN
Last Name:SHWER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:BRIAN
Other - Middle Name:I
Other - Last Name:SHWER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:564 GOODMAN RD E
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-9526
Mailing Address - Country:US
Mailing Address - Phone:662-470-5589
Mailing Address - Fax:662-349-0550
Practice Address - Street 1:564 GOODMAN RD E
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-9526
Practice Address - Country:US
Practice Address - Phone:622-349-7333
Practice Address - Fax:662-349-0550
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM458213ES0131X
MS80146213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2740040OtherUNITED HEALTHCARE
TN3021189OtherBCBS TN
TN5436037OtherAETNA
MS00119449Medicaid
TN3352407Medicaid
TN3021189OtherBCBS TN
TN5436037OtherAETNA
MS480035259Medicare PIN
TN480019845Medicare PIN
TN3352407Medicare PIN
U56828Medicare UPIN