Basic Information
| Provider Information | |||||||||
| NPI: | 1376530899 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHANER | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | ALLEN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1821 HILLANDALE RD | ||||||||
| Address2: | SUITE 24B | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277052659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193835437 | ||||||||
| FaxNumber: | 9193837694 | ||||||||
| Practice Location | |||||||||
| Address1: | 1901 HILLANDALE RD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277052664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193835437 | ||||||||
| FaxNumber: | 9193837694 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2005 | ||||||||
| LastUpdateDate: | 01/30/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 01055766A | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.