Healthcare Provider Details

I. General information

NPI: 1982999322
Provider Name (Legal Business Name): LORNA JEAN SHANKS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 04/27/2025
Certification Date: 04/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 NE BROADWAY ST STE 109
PORTLAND OR
97232-1500
US

IV. Provider business mailing address

2100 NE BROADWAY ST STE 109
PORTLAND OR
97232-1500
US

V. Phone/Fax

Practice location:
  • Phone: 503-832-0607
  • Fax: 503-386-3373
Mailing address:
  • Phone: 503-832-0607
  • Fax: 503-386-3373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD169271
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: