Healthcare Provider Details

I. General information

NPI: 1508034331
Provider Name (Legal Business Name): BRIAN SHWER,DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

564 GOODMAN RD E
SOUTHAVEN MS
38671-9526
US

IV. Provider business mailing address

564 GOODMAN RD E
SOUTHAVEN MS
38671-9526
US

V. Phone/Fax

Practice location:
  • Phone: 662-349-7333
  • Fax: 662-349-0550
Mailing address:
  • Phone: 662-349-7333
  • Fax: 662-349-0550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberDPM458
License Number StateTN

VIII. Authorized Official

Name: BRIAN I SHWER
Title or Position: OWNER
Credential: DPM
Phone: 662-349-7333