OrganizationActive
Providence Health & Services - Oregon
NPI 1235479643 · Sports Medicine (Internal Medicine) Physician · Portland, OR
Provider details
- NPI number
- 1235479643
- Entity type
- Organization
- Primary specialty
- Sports Medicine (Internal Medicine) PhysicianAllopathic & Osteopathic Physicians
- Authorized official
- Donald Anderson, Assistant Secreatry for Enrollment
Practice location
909 Sw 18th Ave
Portland, OR 97205-1705
Phone: (503) 962-1946
Fax: (503) 962-1925
Mailing address
Po Box 31001 - 4180
Pasadena, CA 91110-4180
Registry dates
- Enumerated
- 2013-02-21
- Last updated
- 2025-07-04
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.