Organization · Type 2 NPI

Providence Health & Services - Oregon

Family Medicine Physician · Lake Oswego, OR

NPI number 1205937273 Active

Practice location

4004 Kruse Way Pl Ste 300
Lake Oswego, OR 97035-2479

Call (503) 216-1500 Map

Mailing address

PO Box 31001 - 4180
Pasadena, CA 91110-4180

Specialties and licenses

Taxonomy	Code	License
Family Medicine Physician Primary	207Q00000X	None listed
Physical Therapist	225100000X	None listed
Clinic/Center	261Q00000X	None listed

Family Medicine Physician: Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

26 other providers at this address

Other family medicine physician providers in Lake Oswego

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NPI record

NPI: 1205937273
Entity type: Organization (Type 2)
Issued: Sep 25, 2006
Last updated: Jul 4, 2025
Status: Active

Other names

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Providence Medical Group · doing business as
Providence Medical Group Mercantile · doing business as

Authorized official

Donald Wayne Anderson
Assistant Secreatry for Enrollment
(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 1205937273

Providence Health & Services - Oregon's National Provider Identifier is 1205937273, issued on Sep 25, 2006. The primary taxonomy on file is Family Medicine Physician (207Q00000X), and the practice location is in Lake Oswego, OR. The record was last updated on Jul 4, 2025.