NPI 1053419218

Providence Health & Services - Oregon

Organisation Family Medicine Physician Gresham, OR

Practice location

Address: 440 NW Division St, Gresham, OR 97030-5506
Phone: (503) 215-9500
Fax: (503) 215-9525
Mailing address: PO Box 31001 - 4180, Pasadena, CA 91110-4180

Authorised official

Name: Donald W Anderson
Title: Asst Sec Enroll
Phone: (425) 358-9786

Registered specialties (3)

Family Medicine Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207Q00000X

Other Family Medicine providers in Oregon →

Endocrinology, Diabetes & Metabolism Physician

Allopathic & Osteopathic Physicians Taxonomy 207RE0101X

Other Internal Medicine providers in Oregon →

Clinic/Center

Ambulatory Health Care Facilities Taxonomy 261Q00000X

Other Clinic/Center providers in Oregon →

Registry record

NPI: 1053419218
Entity type: Organization
NPI issued: 20 Sep 2006
Record last updated: 20 Jun 2025

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.