Provider Demographics
NPI:1265447759
Name:BRAZIEL, RITA MERLE (MD)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:MERLE
Last Name:BRAZIEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD # L471
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-9773
Mailing Address - Country:US
Mailing Address - Phone:503-494-8276
Mailing Address - Fax:503-494-2025
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD #L471
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-9773
Practice Address - Country:US
Practice Address - Phone:503-494-8276
Practice Address - Fax:503-494-2025
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD13970207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR271510Medicaid
OR271510Medicaid