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

Providence Health & Services - Oregon

Organization Internal Medicine Physician · NPI 1235479643

Providence Health & Services - Oregon is an Internal Medicine Physician in Portland, Oregon. Registered with an NPI since 2013.

In the registry since
2013
Specialties on file
3
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Practice location Address checks out

909 SW 18th Ave
Portland, OR 97205-1705
Phone: (503) 962-1946
Fax: (503) 962-1925
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Sports Medicine (Internal Medicine) Physician (primary) Taxonomy 207RS0010X
Internal Medicine Physician Taxonomy 207R00000X
Clinic/Center Taxonomy 261Q00000X

Record details

NPI number1235479643
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 Sports Care
NPI enumeratedFebruary 21, 2013
Last updated in NPPESJuly 4, 2025
Certification dateJuly 4, 2025
Mailing addressPo Box 31001 - 4180, Pasadena, CA 91110-4180

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