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General NPI Number Information
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NPI Number | 1184697484
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Entity Type | Individual
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Provider Name | SHANE KEITH BACKUS MD
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Gender | Male
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Dates
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Enumeration Date | 02/08/2006
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Last Update Date | 06/02/2022
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Provider Practice Location Address
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Address Line | 838 MARKET STREET
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City | ZANESVILLE
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State | OH
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Zip | 43701
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Country | US
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Telephone | 740-452-9319
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Fax | 740-452-2427
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Provider Business Mailing Address
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Address Line | 13333 NORTHWEST FWY STE 540
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City | HOUSTON
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State | TX
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Zip | 77040-6166
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Country | US
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Telephone | 740-452-9319
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Fax | 740-452-2427
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 35082724
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License Number State | OH
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