Search › Oregon › 171100000X
John Shade
NPI 1558855312 · on the registry since 2018
Practice
- Address
- 914 Sw 11th Ave
Portland, OR 97205 - Phone
- (503) 427-9358
- Organisation at this address
- Revivanation Llc
Inferred from a shared address, not stated in the registry.
- Clinicians at this address
- 10
Registry record
- Primary taxonomy
- 171100000X
171100000X
- Licence states on file
- OR
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2018-06-15
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Oregon