Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Other names
PROVIDENCE MEDICAL GROUP, PROVIDENCE MEDICAL GROUP NEUROLOGY ASSOCIATES
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENT)
(425) 358-9786
Entity
Organization
Contact information
Practice address
10330 SE 32ND AVE, SUITE 226, MILWAUKIE, OR 97222-6699
(503) 513-8020
(503) 513-8025
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4150
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
213813
—
OR
Enumeration date
01/09/2008
Last updated
07/04/2025
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