Healthcare Provider Details

I. General information

NPI: 1427166982
Provider Name (Legal Business Name): SHANNON S. BRIGMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2006
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 N VILLA RD
NEWBERG OR
97132-1833
US

IV. Provider business mailing address

2152 NW FLANDERS ST
PORTLAND OR
97210-3406
US

V. Phone/Fax

Practice location:
  • Phone: 503-554-0036
  • Fax: 503-538-9257
Mailing address:
  • Phone: 520-395-6637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number150760
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: