Healthcare Provider Details

I. General information

NPI: 1881611549
Provider Name (Legal Business Name): HOWARD M GRAITZER DO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 06/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6040 SE BELMONT ST
PORTLAND OR
97215-1974
US

IV. Provider business mailing address

PO BOX 66500
PORTLAND OR
97290-6500
US

V. Phone/Fax

Practice location:
  • Phone: 503-872-3283
  • Fax: 866-950-4463
Mailing address:
  • Phone: 360-254-3663
  • Fax: 866-950-4463

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: HOWARD M GRAITZER
Title or Position: OWNER
Credential: D.O.
Phone: 503-872-3283