OrganizationActive
Providence Health & Services - Oregon
NPI 1083714141 · Dermatology Physician · Portland, OR
Provider details
- NPI number
- 1083714141
- Entity type
- Organization
- Primary specialty
- Dermatology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Donald Anderson, Asst Sec Enroll(425) 358-9786
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Clinic/Center261Q00000X
Ambulatory Health Care Facilities
Profile Score
Detailed profile(90/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
417 Sw 117th Ave
2nd Floor
Portland, OR 97225-5924
Phone: (503) 216-9400
Fax: (503) 216-9499
Street-level locationGet directions
Mailing address
Po Box 31001 - 4180
Pasadena, CA 91110-4180
Other names (DBA / former)
- Doing business as
- Providence Medical Group
- Doing business as
- Providence Medical Group Sunset
Registry dates
- Enumerated
- 2006-09-25
- Last updated
- 2025-06-20
- Certified
- 2025-06-20
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.