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Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Other names
Providence Peds Spec MJP, PROVIDENCE MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD W ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
9427 SW BARNES RD, SUITE 598, PORTLAND, OR 97225-6652
(503) 216-8654
(503) 216-8658
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
(503) 215-6494
(503) 215-6644
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022858
—
OR
Enumeration date
10/17/2006
Last updated
06/20/2025
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