Provider Demographics
NPI:1154379824
Name:SHEAR, MARY BETH (MD)
Entity type:Individual
Prefix:
First Name:MARY BETH
Middle Name:
Last Name:SHEAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 N DEWEY AVENUE
Mailing Address - Street 2:
Mailing Address - City:REEDSBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53959
Mailing Address - Country:US
Mailing Address - Phone:608-524-6477
Mailing Address - Fax:608-524-8305
Practice Address - Street 1:1900 N DEWEY AVE
Practice Address - Street 2:
Practice Address - City:REEDSBURG
Practice Address - State:WI
Practice Address - Zip Code:53959-2214
Practice Address - Country:US
Practice Address - Phone:608-524-6477
Practice Address - Fax:608-524-8305
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI51006207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34965000Medicaid
IL036067267Medicaid
WI34965000Medicaid
ILP07581Medicare ID - Type Unspecified