Organization · Type 2 NPI

Providence Health & Services - Oregon

Neurology with Special Qualifications in Child Neurology Physician · Portland, OR

NPI number 1316125149 Active

Practice location

9427 SW Barnes Rd Ste 395
Portland, OR 97225-6652

Call (503) 216-1280 Map

Fax (503) 216-1288

Mailing address

PO Box 3158
Portland, OR 97208-3158

Specialties and licenses

Taxonomy	Code	License
Neurology with Special Qualifications in Child Neurology Physician Primary	2084N0402X	None listed
Clinic/Center	261Q00000X	None listed

Neurology with Special Qualifications in Child Neurology Physician: A Child Neurologist specializes in neurology with special skills in diagnosis and treatment of neurologic disorders of the neonatal period, infancy, early childhood, and adolescence.

20 other providers at this address

NPI record

NPI: 1316125149
Entity type: Organization (Type 2)
Issued: Feb 4, 2008
Last updated: Jul 4, 2025
Status: Active

Other names

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Providence Medical Group · doing business as
Providence Pediatric Neurology MJP · doing business as

Authorized official

Donald Wayne Anderson
Assistant Secretary Enrollment
(425) 358-9786

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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 1316125149

Providence Health & Services - Oregon's National Provider Identifier is 1316125149, issued on Feb 4, 2008. The primary taxonomy on file is Neurology with Special Qualifications in Child Neurology Physician (2084N0402X), and the practice location is in Portland, OR. The record was last updated on Jul 4, 2025.