Healthcare Provider Details

I. General information

NPI: 1457340457
Provider Name (Legal Business Name): SHAWN THOMAS NESBO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 SUNSET BLVD SUITE 4
CONRAD MT
59425-1799
US

IV. Provider business mailing address

1101 26TH ST S
GREAT FALLS MT
59405-5161
US

V. Phone/Fax

Practice location:
  • Phone: 406-271-3231
  • Fax: 406-271-3576
Mailing address:
  • Phone: 406-731-8817
  • Fax: 406-731-8876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8202
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number8202
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: