National Provider Identifier Database

PROVIDENCE HEALTH SERVICES OREGON
Hematology & Oncology

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.


Contact Information

PROVIDENCE HEALTH & SERVICES OREGON
4805 NE GLISAN ST STE 11N
PORTLAND, OR97213-2933
Phone: 503-215-8650
Fax: 503-215-8653
Website:
Specialty Taxonomy Code
* Hematology & Oncology 207RH0003X
Clinic/Center 261Q00000X
Hepatology 207RI0008X
Medical Oncology 207RX0202X
Surgery 208600000X
Surgical Oncology 2086X0206X

* Indicates primary specialty

NPI Profile & details for PROVIDENCE HEALTH & SERVICES OREGON

NPI Number 1801010004
Legal business name
LBN
PROVIDENCE HEALTH & SERVICES OREGON
Authorized official DONALD ANDERSON - (ASST SECRETARY FOR ENROLLMENTS)
Entity Organization
Organization subpart No
Enumeration date 04/12/2007
Last updated 07/04/2025 - About 11 months ago
Sole proprietor1 Not specified
Identifiers
  • OR Medicaid: 274461

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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