Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Other names
PROVIDENCE MEDICAL GROUP WILSONVILLE, PROVIDENCE MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASST SEC FOR ENROLLMENT)
(425) 358-9786
Entity
Organization
Contact information
Practice address
29345 SW TOWN CENTER LOOP E, SUITE 110, WILSONVILLE, OR 97070-8486
(503) 582-2100
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Enumeration date
09/17/2008
Last updated
06/20/2025
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