Individual
SHANE M COLEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., MPH
Contact information
Practice address
2600 NE NEFF RD, BEND, OR 97701-6337
(541) 706-4800
(541) 706-4806
Mailing address
880 SW THEATER DR, BEND, OR 97702-3509
(206) 310-9452
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
7728
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1083819
—
WA
01
—
232258
MEDICAL TRAINING/LIMITED LICENSE
MA
01
—
246201
MEDICAL LICENSE
MA
01
—
6810
MEDICAL LICENSE - TEMP
AK
01
—
7728
MEDICAL LICENS
AK
01
—
MD00372
ALASKA MEDICAID PROVIDER NUMBER
AK
01
—
MD60212882
MEDICAL LICENSE
WA
Enumeration date
06/15/2007
Last updated
02/14/2023
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