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 1770723017

Providence Health & Services - Oregon is a Dermatology Physician in Tigard, Oregon. Registered with an NPI since 2009.

In the registry since
2009
Specialties on file
2

Practice location Address checks out

18040 SW Lowr Boones Ferry RD Ste 100
Tigard, OR 97224-7215
Phone: (503) 216-0700
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 number1770723017
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationProvidence Health & Services - Oregon
Authorized official Donald Anderson — Assistant Secretary Enrollment · (425) 358-9786
Other names Pmg Bridgeport Dermatology; Providence Medical Group
NPI enumeratedFebruary 26, 2009
Last updated in NPPESJuly 1, 2025
Certification dateJuly 1, 2025
Mailing addressPo Box 31001 - 4180, Pasadena, CA 91110-4180

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