Provider Demographics
NPI:1457340457
Name:NESBO, SHAWN THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:THOMAS
Last Name:NESBO
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 1:1101 26TH ST S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-5161
Mailing Address - Country:US
Mailing Address - Phone:406-731-8817
Mailing Address - Fax:406-731-8876
Practice Address - Street 1:809 SUNSET BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:CONRAD
Practice Address - State:MT
Practice Address - Zip Code:59425-1799
Practice Address - Country:US
Practice Address - Phone:406-271-3231
Practice Address - Fax:406-271-3576
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8202207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine