Individual
JILL MARIE SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
6564 SE LAKE RD STE 200, MILWAUKIE, OR 97222-2237
(503) 908-5880
(888) 475-8729
Mailing address
6564 SE LAKE RD STE 200, MILWAUKIE, OR 97222-2237
(503) 908-5880
(888) 475-8729
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
DO25570
OR
207VG0400X
Gynecology Physician
Primary
DO25570
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1770576340
—
WA
05
—
213528
—
OR
01
—
218071
MEDICARE PIN
—
Enumeration date
08/29/2005
Last updated
05/18/2020
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