Provider Demographics
NPI:1730380999
Name:O'BRIEN, SHANNON PARKER (MD)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:PARKER
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 NW NAITO PARKWAY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209
Mailing Address - Country:US
Mailing Address - Phone:503-292-9200
Mailing Address - Fax:503-292-9205
Practice Address - Street 1:1200 NW NAITO PARKWAY
Practice Address - Street 2:SUITE 310
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209
Practice Address - Country:US
Practice Address - Phone:503-292-9200
Practice Address - Fax:503-292-9205
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35088024208200000X
ORMD28292208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery