Organization · Type 2 NPI

Providence Health & Services - Oregon

Otolaryngology Physician · The Dalles, OR

NPI number 1083963573 Active

Practice location

1815 E 19th St, Suite 1
The Dalles, OR 97058-3385

Call (541) 298-5563 Map

Mailing address

PO Box 31001-4180
Pasadena, CA 91110-4118

Specialties and licenses

Taxonomy	Code	License
Otolaryngology Physician Primary	207Y00000X	None listed
Clinic/Center	261Q00000X	None listed

Otolaryngology Physician: An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injurie…

5 other providers at this address

Other otolaryngology physician providers in The Dalles

Columbia Gorge Ent, LLCOtolaryngology Physician The Dalles, OR NPI 1427056324

See all in The Dalles →

NPI record

NPI: 1083963573
Entity type: Organization (Type 2)
Issued: Aug 30, 2012
Last updated: Jun 20, 2025
Status: Active

Other names

<unavail>
Providence Medical Group · doing business as
Providence the Dalles Ent · doing business as

Authorized official

Mr. Donald W Anderson
Assistant Secretary of Enrollments
(425) 358-9786

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1083963573

Providence Health & Services - Oregon's National Provider Identifier is 1083963573, issued on Aug 30, 2012. The primary taxonomy on file is Otolaryngology Physician (207Y00000X), and the practice location is in The Dalles, OR. The record was last updated on Jun 20, 2025.