Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Parent organization
PROVIDENCE HEALTH & SERVICES - OREGON
Other names
PROVIDENCE PEDIATRIC SPECIALTIES III, PROVIDENCE MEDICAL GROUP
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE HEALTH & SERVICES - OREGON
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECREATRY FOR ENROLLMENT)
(425) 358-9786
Entity
Organization
Contact information
Practice address
1321 NE 99TH AVE, SUITE 200, PORTLAND, OR 97220-9436
(503) 216-8654
(503) 216-8658
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
(503) 215-6494
(503) 215-6644
Taxonomy
Speciality
Code
Description
License number
State
2086S0120X
Pediatric Surgery Physician
Primary
—
—
Other
Enumeration date
10/17/2006
Last updated
07/04/2025
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