Shore, Brian Neal

Shore, Brian Neal is an individual health care provider with primary practice located at 2110 Fox Dr , Champaign IL 61820-7553. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Shore, Brian Neal can be contacted via phone (217) 366-1237.

Contact Information

Primary practice address
2110 Fox Dr Champaign IL 61820-7553
Phone: (217) 366-1237
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 085002428 Illinois

Profile Details

NPI number 1376544585
LBN Legal business name Shore, Brian Neal
Credentials PA C
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 10th, 2005
Last updated Mar 17th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1376544585 NPPES
Illinois Other 434110 MEDICARE GROUP
Illinois Other P00382778 MEDICARE GROUP

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