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Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Other names
PROVIDENCE MEDICAL GROUP, PMG BRIDGEPORT
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD W ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENT)
(425) 525-5392
Entity
Organization
Contact information
Practice address
18040 SW LOWER BOONES FERRY RD, SUITE 100, TIGARD, OR 97224-7215
(503) 216-0700
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
NULL
207N00000X
Dermatology Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
2084N0400X
Neurology Physician
—
NULL
2084N0400X
Neurology Physician
—
—
261Q00000X
Clinic/Center
—
NULL
Other
Enumeration date
06/25/2008
Last updated
07/04/2025
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