Provider Demographics
NPI:1770562332
Name:SHEARER, DOUGLAS R (MD)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:R
Last Name:SHEARER
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:N204 POTTAWATOMI TRL
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WI
Mailing Address - Zip Code:53563-9501
Mailing Address - Country:US
Mailing Address - Phone:906-458-0198
Mailing Address - Fax:
Practice Address - Street 1:515 22ND AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-1569
Practice Address - Country:US
Practice Address - Phone:608-324-2000
Practice Address - Fax:608-324-1246
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI49875-20208D00000X
MI055770207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI1247001OtherINDIVIDUAL PTAN
MI1770562332OtherMEDICARE INDIVIDUAL PTAN
MI3475858Medicaid
MI1356594691OtherMEDICARE GR UPIN
MI2805583Medicaid
MIMI1247OtherMEDICARE GROUP PTAN
MI1770562332OtherMEDICARE INDIVIDUAL PTAN