Healthcare Provider Details

I. General information

NPI: 1215953724
Provider Name (Legal Business Name): HOWARD M GRAITZER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 12/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6808 SE 28TH AVE
PORTLAND OR
97202-8705
US

IV. Provider business mailing address

6808 SE 28TH AVE
PORTLAND OR
97202-8705
US

V. Phone/Fax

Practice location:
  • Phone: 503-957-8620
  • Fax: 888-939-4463
Mailing address:
  • Phone: 503-957-8620
  • Fax: 888-939-4453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberDO18678
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: