Provider Demographics
NPI:1912201062
Name:SHANK, AUDREY CHAPIN (MD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:CHAPIN
Last Name:SHANK
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 1:600 RANCH RD
Mailing Address - Street 2:
Mailing Address - City:REEDSPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97467-1795
Mailing Address - Country:US
Mailing Address - Phone:541-271-2171
Mailing Address - Fax:541-271-6380
Practice Address - Street 1:620 RANCH RD
Practice Address - Street 2:
Practice Address - City:REEDSPORT
Practice Address - State:OR
Practice Address - Zip Code:97467-1720
Practice Address - Country:US
Practice Address - Phone:541-271-2163
Practice Address - Fax:541-271-4058
Is Sole Proprietor?:No
Enumeration Date:2011-01-04
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227422207Q00000X
ORMD153148207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine