Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Other names
Providence Medical Group Glisan Dermatology at Sunnyside, PROVIDENCE MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASST SEC ENROLLMENT)
(425) 358-9786
Entity
Organization
Contact information
Practice address
9290 SE SUNNYBROOK BLVD, SUITE 120, CLACKAMAS, OR 97015-6802
(503) 215-9080
(503) 215-9099
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Enumeration date
01/06/2014
Last updated
07/01/2025
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