Provider Demographics
NPI:1063647949
Name:WRAZEN & RASH PC, PHYSICIANS
Entity Type:Organization
Organization Name:WRAZEN & RASH PC, PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RASH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-265-5362
Mailing Address - Street 1:775 SW 9TH STREET
Mailing Address - Street 2:ANNEX A
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365
Mailing Address - Country:US
Mailing Address - Phone:541-265-5362
Mailing Address - Fax:541-265-9304
Practice Address - Street 1:775 SW 9TH STREET
Practice Address - Street 2:ANNEX A
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365
Practice Address - Country:US
Practice Address - Phone:541-265-5362
Practice Address - Fax:541-265-9304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD17873208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR073994Medicaid
OR073994Medicaid