Provider Demographics
NPI:1811953177
Name:SHOWN, TIM (DO)
Entity type:Individual
Prefix:
First Name:TIM
Middle Name:
Last Name:SHOWN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 E JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-8417
Mailing Address - Country:US
Mailing Address - Phone:870-932-8222
Mailing Address - Fax:870-934-3455
Practice Address - Street 1:4901 E JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-8417
Practice Address - Country:US
Practice Address - Phone:870-932-8222
Practice Address - Fax:870-934-3455
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-3093207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARH44957Medicare UPIN
AR5M005Medicare ID - Type Unspecified