Provider Demographics
NPI:1629025473
Name:SHILLAND, ERIC WILLIAM (DO)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:WILLIAM
Last Name:SHILLAND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8084 SE 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-6662
Mailing Address - Country:US
Mailing Address - Phone:503-231-3371
Mailing Address - Fax:503-716-4681
Practice Address - Street 1:8084 SE 15TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-6662
Practice Address - Country:US
Practice Address - Phone:503-231-3371
Practice Address - Fax:503-716-4681
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO27920204D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1629025473Medicaid
OR226982Medicaid
MEE55318Medicare UPIN
OR226982Medicaid
WA1629025473Medicaid
R140084Medicare PIN