Provider Demographics
NPI:1730164591
Name:SHIMKUS, BRIAN JAY (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:JAY
Last Name:SHIMKUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 749495
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9495
Mailing Address - Country:US
Mailing Address - Phone:394-328-3312
Mailing Address - Fax:813-321-1296
Practice Address - Street 1:3201 S AUSTIN AVE STE 315
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-7642
Practice Address - Country:US
Practice Address - Phone:512-358-9428
Practice Address - Fax:737-710-1920
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL5907207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157781901Medicaid
TX27219YN57Medicare PIN
TX272191YN56Medicare PIN