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General NPI Number Information
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NPI Number | 1770576340
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Entity Type | Individual
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Provider Name | JILL MARIE SHAW D.O.
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Gender | Female
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Dates
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Enumeration Date | 08/29/2005
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Last Update Date | 05/18/2020
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Provider Practice Location Address
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Address Line | 6564 SE LAKE RD STE 200
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City | MILWAUKIE
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State | OR
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Zip | 97222-2237
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Country | US
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Telephone | 503-908-5880
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Fax | 888-475-8729
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Provider Business Mailing Address
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Address Line | 6564 SE LAKE RD STE 200
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City | MILWAUKIE
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State | OR
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Zip | 97222-2237
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Country | US
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Telephone | 503-908-5880
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Fax | 888-475-8729
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | DO25570
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | DO25570
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License Number State | OR
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