Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Other names
PROVIDENCE MEDICAL GROUP, Providence Genetic Risk Assessmet East
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
4805 NE GLISAN ST STE 11N, PORTLAND, OR 97213-2933
(503) 215-7901
(503) 215-7904
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
Taxonomy
Speciality
Code
Description
License number
State
207SG0201X
Clinical Genetics (M.D.) Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Enumeration date
07/03/2014
Last updated
03/23/2026
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