Provider Demographics
NPI:1508034331
Name:BRIAN SHWER,DPM
Entity type:Organization
Organization Name:BRIAN SHWER,DPM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:I
Authorized Official - Last Name:SHWER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:662-349-7333
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:662-349-7333
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:662-349-7333
Practice Address - Fax:662-349-0550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM458332B00000X
TN213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1067150001Medicare NSC
TN3352407Medicare PIN
TN103G485221Medicare PIN