Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Providence Health & Services - Oregon

Organization Family Medicine Physician · NPI 1053419218

Providence Health & Services - Oregon is a Family Medicine Physician in Gresham, Oregon. Works from 2 locations. Registered with an NPI since 2006.

In the registry since
2006
Specialties on file
3

Practice location Address checks out

440 NW Division St
Gresham, OR 97030-5506
Phone: (503) 215-9500
Fax: (503) 215-9525
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 5211 Ne Glisan St Bldg C, Portland, OR 97213-3052 — (503) 215-6601

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X
Endocrinology, Diabetes & Metabolism Physician Taxonomy 207RE0101X
Clinic/Center Taxonomy 261Q00000X

Record details

NPI number1053419218
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Donald Anderson — Asst Sec Enroll · (425) 358-9786
Other names Providence Medical Group
NPI enumeratedSeptember 20, 2006
Last updated in NPPESJune 20, 2025
Certification dateJune 20, 2025
Mailing addressPo Box 31001 - 4180, Pasadena, CA 91110-4180

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