Healthcare Provider Details

I. General information

NPI: 1588667414
Provider Name (Legal Business Name): BRIAN IVAN SHWER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BRIAN I SHWER DPM

II. Dates (important events)

Enumeration Date: 05/24/2005
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: 622-349-7333
  • Fax: 662-349-0550
Mailing address:
  • Phone: 662-470-5589
  • Fax: 662-349-0550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberDPM458
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number80146
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: