Provider Demographics
NPI:1194761817
Name:MCCANN, SHAWN ELLINGTON (MD)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:ELLINGTON
Last Name:MCCANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6 CENTERPOINTE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-8653
Mailing Address - Country:US
Mailing Address - Phone:503-797-2254
Mailing Address - Fax:503-914-0335
Practice Address - Street 1:13200 SW PACIFIC HWY
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-4828
Practice Address - Country:US
Practice Address - Phone:503-598-2000
Practice Address - Fax:503-639-0920
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2022-02-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC2005-00541207Q00000X
LA022900207Q00000X
CAC50813207Q00000X
ORMD161972207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1582816Medicaid
LAI33517Medicare UPIN
LA1582816Medicaid