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 1205937273

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

In the registry since
2006
Specialties on file
3

Practice location Address checks out

4004 Kruse Way Pl Ste 300
Lake Oswego, OR 97035-2479
Phone: (503) 216-1500
Show map & directions

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

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X
Physical Therapist Taxonomy 225100000X
Clinic/Center Taxonomy 261Q00000X

Record details

NPI number1205937273
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Donald Anderson — Assistant Secreatry For Enrollment · (425) 358-9786
Other names Providence Medical Group; Providence Medical Group Mercantile
NPI enumeratedSeptember 25, 2006
Last updated in NPPESJuly 4, 2025
Certification dateJuly 4, 2025
Mailing addressPo Box 31001 - 4180, Pasadena, CA 91110-4180

Other providers in Lake Oswego