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Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Other names
PROVIDENCE MEDICAL GROUP, Providence Oral Head and neck Cancer Clinic North
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD W ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENT)
(425) 358-9786
Entity
Organization
Contact information
Practice address
830 NE 47TH AVE, PORTLAND, OR 97213-2212
(503) 215-3053
(503) 215-3037
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
—
NULL
207RH0003X
Hematology & Oncology Physician
Primary
—
—
261Q00000X
Clinic/Center
—
NULL
Other
Enumeration date
11/21/2012
Last updated
07/01/2025
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