Individual
DR. TATYANA EVGENIEVA SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1414 NW NORTHRUP ST STE 600, PORTLAND, OR 97209-2790
(503) 223-3104
(503) 223-4619
Mailing address
541 NE 20TH AVE STE 225, PORTLAND, OR 97232-2895
(503) 963-2801
(503) 963-2825
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
MD29239
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500400318
—
OR
01
—
P01282329
RR MEDICARE - PHS 931097258
OR
Enumeration date
07/13/2007
Last updated
11/21/2023
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