Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | DO18678 | OR |
NPI | 1215953724 |
---|---|
Provider Name | Howard M Graitzer |
First Address | Portland, OR 97202-8705 |
Second Address | Portland, OR 97202-8705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 04/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
134120 | (05) | OR |
D75137 | (02) | OR |