Provider Demographics
NPI:1215953724
Name:GRAITZER, HOWARD M (DO)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:M
Last Name:GRAITZER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6808 SE 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-8705
Mailing Address - Country:US
Mailing Address - Phone:503-957-8620
Mailing Address - Fax:888-939-4453
Practice Address - Street 1:6808 SE 28TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-8705
Practice Address - Country:US
Practice Address - Phone:503-957-8620
Practice Address - Fax:888-939-4463
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO18678207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR134120Medicaid
OR134120Medicaid
ORD75137Medicare UPIN