Provider Demographics
NPI:1174745418
Name:RAYMOND BRACIS, MD
Entity type:Organization
Organization Name:RAYMOND BRACIS, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:B
Authorized Official - Last Name:BRACIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-240-1844
Mailing Address - Street 1:8316 N LOMBARD ST PMB#324
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203
Mailing Address - Country:US
Mailing Address - Phone:503-240-1844
Mailing Address - Fax:
Practice Address - Street 1:1015 NW 22ND AVE #R200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210
Practice Address - Country:US
Practice Address - Phone:503-413-8258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR017418Medicaid
OR017418Medicaid
C92263Medicare UPIN