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NPI Code Detail

MEDICARE: SHANE M COLEMAN M.D., MPH

MEDICARE: SHANE M COLEMAN M.D., MPH
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
12084P0800XPsychiatry Physician7728AK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1246201OTHERMAMEDICAL LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3232258OTHERMAMEDICAL TRAINING/LIMITED LICENSE
46810OTHERAKMEDICAL LICENSE - TEMP
5MD60212882OTHERWAMEDICAL LICENSE
67728OTHERAKMEDICAL LICENS
7MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083819692
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANE M COLEMAN M.D., MPH
Provider Business Mailing Address
First Line : 880 SW THEATER DR
Second Line :
City : BEND
State : OR
Zip : 97702-3509
Country : US
Telephone Number : 206-310-9452
Fax Number :
Provider Business Practice Location Address
First Line : 2600 NE NEFF RD
Second Line :
City : BEND
State : OR
Zip : 97701-6337
Country : US
Telephone Number : 541-706-4800
Fax Number : 541-706-4806
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2007
Last Update Date : 05/20/2026

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