Provider Demographics
NPI:1760823900
Name:BROWN, ANDREW SHIELDS (PA-C)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:SHIELDS
Last Name:BROWN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10000 SE MAIN ST STE 365
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2474
Mailing Address - Country:US
Mailing Address - Phone:503-261-4430
Mailing Address - Fax:
Practice Address - Street 1:10000 SE MAIN ST STE 365
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2474
Practice Address - Country:US
Practice Address - Phone:503-261-4430
Practice Address - Fax:503-261-4436
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT055-0031643363A00000X
WYPA662363A00000X
WAPA60485019363A00000X
VA0110008975363A00000X
WA390200000X
ORPA213593363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program