PROVIDENCE HEALTH & SERVICES - OREGON
NPI 1124325972
Internal Medicine - Hematology & Oncology in Portland, OR

Q: What is Providence Health & Services - Oregon's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Hematology & Oncology, with taxonomy code 207RH0003X.

Active since February 14, 2011

4805 NE GLISAN ST STE 11N, PORTLAND, OR 97213(503) 215-1600(503) 215-1600 Get Directions Write a Review

NPPES record last updated: March 23, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Mar 23, 2026, Jun 20, 2025, May 16, 2025 and 1 more (4 updates tracked since 2024).

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About Providence Health & Services - Oregon NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PROVIDENCE HEALTH & SERVICES - OREGON (NPI 1124325972), doing business as Providence Dysplasia Clinic, is a healthcare organization registered as a hematology & oncology in Portland, Oregon and active in the NPI registry since February 2011. The organization lists Donald Wayne Anderson, Assistant Secretary Of Enrollments, as its authorized official.

NPPES Registry Identity

NPI1124325972

Entity TypeOrganization

Primary Taxonomy207RH0003X

Legal Business NamePROVIDENCE HEALTH & SERVICES - OREGON

Location Address4805 NE GLISAN ST STE 11NPortland, OR 97213-2933

Mailing AddressPo Box 31001 - 4180Pasadena, CA 91110-4180 · (503) 215-6494 · Fax (503) 215-6644

Phone(503) 215-1600

Fax(503) 215-1600

Organization SubpartNo

Authorized OfficialDonald Wayne AndersonAssistant Secretary Of Enrollments · (425) 358-9786

Enumeration DateFebruary 14, 2011

Last NPPES UpdateMarch 23, 20264 updates tracked since enumeration

NPPES CertifiedMarch 23, 2026

✔ NPI 1124325972 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal Medicine · Hematology & OncologyAllopathic & Osteopathic Physicians

Taxonomy Code207RH0003X

Definition

An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered.

Also ListedClinic/CenterTaxonomy 261Q00000X

4805 NE GLISAN ST STE 11N, Portland, OR 97213

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Other Names 2

Doing Business AsProvidence Dysplasia Clinic

Doing Business AsProvidence Medical Group

Other Identifiers 1

Medicaid500632601OR

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PROVIDENCE HEALTH & SERVICES - OREGON

Obstetrics & Gynecology