Provider Demographics
NPI:1982999322
Name:SHANKS, LORNA JEAN (MD)
Entity Type:Individual
Prefix:
First Name:LORNA
Middle Name:JEAN
Last Name:SHANKS
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 1:16083 SW UPPER BOONES FERRY RD STE 130
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7737
Mailing Address - Country:US
Mailing Address - Phone:503-603-9087
Mailing Address - Fax:503-603-9122
Practice Address - Street 1:16083 SW UPPER BOONES FERRY RD STE 130
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-7737
Practice Address - Country:US
Practice Address - Phone:503-603-9087
Practice Address - Fax:503-603-9122
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD169271207Q00000X
WAMD 60224198207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine