Provider Demographics
NPI:1184684342
Name:BARRETT, SHAWN A (MD)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:A
Last Name:BARRETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8140 N MOPAC EXPY
Mailing Address - Street 2:SUITE 3-210
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8837
Mailing Address - Country:US
Mailing Address - Phone:512-343-2292
Mailing Address - Fax:512-343-2745
Practice Address - Street 1:3600 NW SAMARITAN DR
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-5472
Practice Address - Country:US
Practice Address - Phone:541-768-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5539207L00000X
ORMD190190207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1051179-02Medicaid
TXH10860Medicare UPIN
TX86856KMedicare ID - Type Unspecified