Provider Demographics
NPI:1831162221
Name:CARREON, BRIAN KEITH (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:KEITH
Last Name:CARREON
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:PO BOX 2088
Mailing Address - Street 2:
Mailing Address - City:SHALLOWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79363-2088
Mailing Address - Country:US
Mailing Address - Phone:806-832-4566
Mailing Address - Fax:806-832-4143
Practice Address - Street 1:1502 12TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:SHALLOWATER
Practice Address - State:TX
Practice Address - Zip Code:79363-5652
Practice Address - Country:US
Practice Address - Phone:806-832-4566
Practice Address - Fax:806-832-4143
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9125207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168484709Medicaid
TX168484708Medicaid
TX8CZ667OtherBCBS OF TEXAS W/ PNS
TX168484709Medicaid
TX8CZ667OtherBCBS OF TEXAS W/ PNS
TXI23938Medicare UPIN
TX8G9622OtherBCBS OF TEXAS
TX8J0208Medicare PIN