Provider Demographics
NPI:1548525918
Name:BRIAN SHWER, DPM
Entity type:Organization
Organization Name:BRIAN SHWER, DPM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
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:2012-07-11
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS80146213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS302G707682Medicare PIN