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

Providence Health & Services - Oregon

Organization Dermatology Physician · NPI 1083714141

Providence Health & Services - Oregon is a Dermatology Physician in Portland, Oregon. Registered with an NPI since 2006.

In the registry since
2006
Specialties on file
2

Practice location Address checks out

417 SW 117th Ave 2nd Fl
Portland, OR 97225-5924
Phone: (503) 216-9400
Fax: (503) 216-9499
Show map & directions

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

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X
Clinic/Center Taxonomy 261Q00000X

Record details

NPI number1083714141
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Donald Anderson — Asst Sec Enroll · (425) 358-9786
Other names Providence Medical Group; Providence Medical Group Sunset
NPI enumeratedSeptember 25, 2006
Last updated in NPPESJune 20, 2025
Certification dateJune 20, 2025
Mailing addressPo Box 31001 - 4180, Pasadena, CA 91110-4180

Other providers in Portland