Organization
PROVIDENCE HEALTH & SERVICES OREGON
Active
Other names
PROVIDENCE MEDICAL GROUP, Providence Pediatric Endocrinology
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD W ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
9427 SW BARNES RD, STE 395, PORTLAND, OR 97225-6652
(503) 216-6050
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
Taxonomy
Speciality
Code
Description
License number
State
2080P0205X
Pediatric Endocrinology Physician
Primary
—
—
2080P0208X
Pediatric Infectious Diseases Physician
—
—
261Q00000X
Clinic/Center
—
—
Other
Enumeration date
12/09/2014
Last updated
06/30/2025
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