Provider Demographics
NPI:1114995735
Name:BRITTAIN, SHELLEY G (MD)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:G
Last Name:BRITTAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:F
Other - Last Name:GLENN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2570 NW EDENBOWER BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-6214
Mailing Address - Country:US
Mailing Address - Phone:541-677-7200
Mailing Address - Fax:541-229-3309
Practice Address - Street 1:1937 W. HARVARD AVE.
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-2720
Practice Address - Country:US
Practice Address - Phone:541-677-7200
Practice Address - Fax:541-229-3309
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD27795207R00000X
SC14990207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR141698OtherMEDICARE TPAN
OR279152Medicaid
SC149903Medicaid
ORE72765Medicare UPIN
OR279152Medicaid