Organization · Type 2 NPI

Providence Health & Services - Oregon

Pediatric Surgery Physician · Portland, OR

NPI number 1659451086 Active

Practice location

1321 NE 99th Ave, Suite 200
Portland, OR 97220-9436

Call (503) 216-8654 Map

Fax (503) 216-8658

Mailing address

PO Box 31001 - 4180
Pasadena, CA 91110-4180

Specialties and licenses

Taxonomy	Code	License
Pediatric Surgery Physician Primary	2086S0120X	None listed

Pediatric Surgery Physician: A surgeon with expertise in the management of surgical conditions in premature and newborn infants, children and adolescents.

55 other providers at this address

NPI record

NPI: 1659451086
Entity type: Organization (Type 2)
Issued: Oct 17, 2006
Last updated: Jul 4, 2025
Status: Active
Subpart: Yes of Providence Health & Services - Oregon

Other names

<unavail>
Providence Medical Group · doing business as
Providence Pediatric Specialties III · 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 1659451086

Providence Health & Services - Oregon's National Provider Identifier is 1659451086, issued on Oct 17, 2006. The primary taxonomy on file is Pediatric Surgery Physician (2086S0120X), and the practice location is in Portland, OR. The record was last updated on Jul 4, 2025.