NPI 1083714141

Providence Health & Services - Oregon

Organisation Dermatology Physician Portland, OR

Practice location

Address: 417 SW 117th Ave 2nd Floor, Portland, OR 97225-5924
Phone: (503) 216-9400
Fax: (503) 216-9499
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 (2)

Dermatology Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207N00000X

Other Dermatology providers in Oregon →

Clinic/Center

Ambulatory Health Care Facilities Taxonomy 261Q00000X

Other Clinic/Center providers in Oregon →

Registry record

NPI: 1083714141
Entity type: Organization
NPI issued: 25 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.