Provider Demographics
NPI:1972814358
Name:SHINABARGER, ANDREW BRYANT (DPM)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:BRYANT
Last Name:SHINABARGER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:2800 N VANCOUVER AVE
Mailing Address - Street 2:SUITE #130
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1630
Mailing Address - Country:US
Mailing Address - Phone:503-413-2005
Mailing Address - Fax:503-413-3699
Practice Address - Street 1:2800 N VANCOUVER AVE
Practice Address - Street 2:SUITE #130
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1630
Practice Address - Country:US
Practice Address - Phone:503-413-2005
Practice Address - Fax:503-413-3699
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASC006229213ES0103X
ORDP164562213ES0103X
WAPO60402238213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery