Basic Information
| Provider Information | |||||||||
| NPI: | 1194761817 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCANN | ||||||||
| FirstName: | SHAWN | ||||||||
| MiddleName: | ELLINGTON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 CENTERPOINTE DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LAKE OSWEGO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970358653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5037972254 | ||||||||
| FaxNumber: | 5039140335 | ||||||||
| Practice Location | |||||||||
| Address1: | 13200 SW PACIFIC HWY | ||||||||
| Address2: | |||||||||
| City: | TIGARD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972234828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035982000 | ||||||||
| FaxNumber: | 5036390920 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2006 | ||||||||
| LastUpdateDate: | 02/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2005-00541 | NC | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 022900 | LA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | C50813 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD161972 | OR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1582816 | 05 | LA | MEDICAID |