Healthcare Provider Details

I. General information

NPI: 1487846267
Provider Name (Legal Business Name): SHAWN MACKENZIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 NE HOYT ST STE 610
PORTLAND OR
97213-2985
US

IV. Provider business mailing address

403 - 223 NELSON'S CRESENT
BURNABY BRITISH COLUMBIA
V3L0E4
CA

V. Phone/Fax

Practice location:
  • Phone: 503-467-4761
  • Fax:
Mailing address:
  • Phone: 604-970-1096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number41830
License Number StateZZ
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number60316843
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberMD160290
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD160290
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: