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Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Other names
PROVIDENCE MEDICAL GROUP SOUTHEAST FAMILY MEDICINE, PROVIDENCE MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD WAYNE ANDERSON JR. (ASST SEC ENROLL)
(425) 358-9786
Entity
Organization
Contact information
Practice address
4104 SE 82ND AVE, SUITE 250, PORTLAND, OR 97266-2954
(503) 215-9850
(503) 215-9855
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
NULL
103T00000X
Psychologist
—
—
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
261Q00000X
Clinic/Center
—
NULL
Other
Enumeration date
09/13/2006
Last updated
06/30/2025
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