MEDICARE: BRIAN JAY SHIMKUS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RX0202X	Medical Oncology Physician	L5907	TX
2	207RH0003X	Hematology & Oncology Physician	L5907	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730164591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN JAY SHIMKUS MD

Provider Business Mailing Address
First Line	:	PO BOX 749495
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-9495
Country	:	US
Telephone Number	:	394-328-3312
Fax Number	:	813-321-1296

Provider Business Practice Location Address
First Line	:	3201 S AUSTIN AVE STE 315
Second Line	:
City	:	GEORGETOWN
State	:	TX
Zip	:	78626-7642
Country	:	US
Telephone Number	:	512-358-9428
Fax Number	:	737-710-1920

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	07/14/2023

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