Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Other names
PROVIDENCE GYNECOLOGIC ONCOLOGY CLINIC, PROVIDENCE MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENT)
(425) 358-9786
Entity
Organization
Contact information
Practice address
4805 NE GLISAN ST STE 11N, PORTLAND, OR 97213-2933
(503) 215-2075
(503) 215-2077
Mailing address
PO BOX 31001-4180, PASADENA, CA 91110-4180
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Enumeration date
10/26/2010
Last updated
03/25/2026
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