Individual
DR. SHANE A AVERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1469 NORTH GARDNER, SCOTTSBURG, IN 47170-0290
(812) 752-1151
(812) 752-1152
Mailing address
1469 NORTH GARDNER, PO BOX 290, SCOTTSBURG, IN 47170-0290
(812) 752-1151
(712) 752-1152
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
01045558A
IN
207Q00000X
Family Medicine Physician
Primary
01045558A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000042772
ANTHEM
IN
05
—
201163750A
—
IN
Enumeration date
10/28/2005
Last updated
03/07/2017
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