Individual
DR. THEODORE ANTHONY BRAICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 NE NEFF RD, BEND, OR 97701-6015
(541) 706-5800
(541) 706-6341
Mailing address
PO BOX 5579, BEND, OR 97708-5579
(541) 706-5800
(541) 706-6341
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
MD24320
OR
207RH0000X
Hematology (Internal Medicine) Physician
MD24320
OR
207RX0202X
Medical Oncology Physician
Primary
MD24320
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00411275
MEDICARE RAILROAD
OR
05
—
226900
—
OR
01
—
P00411275
MEDICARE RAILROAD
OR
Enumeration date
08/01/2006
Last updated
12/14/2016
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