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1558301168
SHANNON E JACKSON
PORTLAND, OR
NPI
1558301168
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
207R00000X Internal Medicine
(Licence: OR MD25874)
Enumeration Date
2006-06-08
Last Update Date
2021-03-18
Business Address
SHANNON E JACKSON MD
4805 NE GLISAN ST
PORTLAND, OR 97213-2933
Phone number: 503-215-2393
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Mailing Address
SHANNON E JACKSON MD
PO BOX 3158
PORTLAND, OR 97208-3158
Phone number:
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