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 1124129903

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

In the registry since
2006
Specialties on file
2

Practice location Address checks out

1321 NE 99th Ave Ste 200
Portland, OR 97220-9439
Phone: (503) 215-4250
Fax: (503) 215-4255
Show map & directions

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

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X
Clinic/Center Taxonomy 261Q00000X

Record details

NPI number1124129903
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Donald Anderson — Assistant Secretary Of Enrollments · (425) 358-9786
Other names Providence Medical Group; Providence Medical Group Gateway Family & Community Medicine
NPI enumeratedSeptember 26, 2006
Last updated in NPPESJune 20, 2025
Certification dateJune 20, 2025
Mailing addressPo Box 31001 - 4180, Pasadena, CA 91110-4180

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