Provider Demographics
NPI:1942445952
Name:GRAFF, JULIE NICOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:NICOLE
Last Name:GRAFF
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 1:3303 SW BOND AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4501
Mailing Address - Country:US
Mailing Address - Phone:503-494-6594
Mailing Address - Fax:503-494-5385
Practice Address - Street 1:3303 SW BOND AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4501
Practice Address - Country:US
Practice Address - Phone:503-494-6594
Practice Address - Fax:503-494-5385
Is Sole Proprietor?:No
Enumeration Date:2008-12-04
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26998390200000X, 207RX0202X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500608788Medicaid
WA2002785OtherMEDICAID
OR500608788Medicaid
ORR149120Medicare PIN