Healthcare Provider Details

I. General information

NPI: 1083819692
Provider Name (Legal Business Name): SHANE M COLEMAN M.D., MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 NE NEFF RD
BEND OR
97701-6337
US

IV. Provider business mailing address

880 SW THEATER DR
BEND OR
97702-3509
US

V. Phone/Fax

Practice location:
  • Phone: 541-706-4800
  • Fax: 541-706-4806
Mailing address:
  • Phone: 206-310-9452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number7728
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: