Provider Demographics
NPI:1982999322
Name:SHANKS, LORNA JEAN (MD)
Entity type:Individual
Prefix:
First Name:LORNA
Middle Name:JEAN
Last Name:SHANKS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 NE BROADWAY ST STE 109
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1500
Mailing Address - Country:US
Mailing Address - Phone:503-832-0607
Mailing Address - Fax:503-386-3373
Practice Address - Street 1:2100 NE BROADWAY ST STE 109
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1500
Practice Address - Country:US
Practice Address - Phone:503-832-0607
Practice Address - Fax:503-386-3373
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD169271207Q00000X
WAMD 60224198207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine