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 1891992624

Providence Health & Services - Oregon is a Dermatology Physician in Portland, Oregon. Registered with an NPI since 2007.

In the registry since
2007
Specialties on file
4

Practice location Address checks out

5330 NE Glisan St Ste 200
Portland, OR 97213-3069
Phone: (503) 215-9080
Show map & directions

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

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X
MOHS-Micrographic Surgery Physician Taxonomy 207ND0101X
Procedural Dermatology Physician Taxonomy 207NS0135X
Clinic/Center Taxonomy 261Q00000X

Record details

NPI number1891992624
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Donald Anderson — Assistant Secretary Enrollment · (425) 358-9786
Other names Providence Medical Group; Providence Medical Group Dermatologic Specialties
NPI enumeratedJune 27, 2007
Last updated in NPPESJuly 4, 2025
Certification dateJuly 4, 2025
Mailing addressPo Box 31001 - 4180, Pasadena, CA 91110-4180

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