Organization
PROVIDENCE HEALTH & SERVICES OREGON
Active
Other names
PROVIDENCE LIVER CANCER CLINIC, PROVIDENCE MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASST SECRETARY FOR ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
4805 NE GLISAN ST STE 11N, PORTLAND, OR 97213-2933
(503) 215-8650
(503) 215-8653
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
—
—
207RI0008X
Hepatology Physician
—
—
207RX0202X
Medical Oncology Physician
—
—
208600000X
Surgery Physician
—
—
2086X0206X
Surgical Oncology Physician
—
—
261Q00000X
Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
274461
—
OR
Enumeration date
04/12/2007
Last updated
07/04/2025
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