Provider Demographics
NPI:1609897867
Name:BRACIS, RAYMOND BENJAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:BENJAMIN
Last Name:BRACIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2801 N GANTENBEIN AVE
Mailing Address - Street 2:RM 4117
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1623
Mailing Address - Country:US
Mailing Address - Phone:503-240-8000
Mailing Address - Fax:503-413-2144
Practice Address - Street 1:2801 N GANTENBEIN AVE
Practice Address - Street 2:RM 4117
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1623
Practice Address - Country:US
Practice Address - Phone:503-240-8000
Practice Address - Fax:503-413-2144
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR09474207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR017418Medicaid
OR017418Medicaid
C92263Medicare UPIN