Provider Demographics
NPI:1912975574
Name:BRADY, RAYMOND E III (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:E
Last Name:BRADY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 EXCHANGE ST.
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103
Mailing Address - Country:US
Mailing Address - Phone:503-325-7546
Mailing Address - Fax:503-325-7343
Practice Address - Street 1:2055 EXCHANGE ST.
Practice Address - Street 2:SUITE 150
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103
Practice Address - Country:US
Practice Address - Phone:503-325-7546
Practice Address - Fax:503-325-7343
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00017613207K00000X
ORMD10611207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD00017613OtherWASHINGTON LICENSE
ORMD10611OtherOREGON LICENSE
ORMD10611OtherOREGON LICENSE
A08030Medicare UPIN
ORR03WCJTTBMedicare PIN