1114926409 NPI number — MR. ROBERT A GRAOR MD

Table of content: MR. ROBERT A GRAOR MD (NPI 1114926409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114926409 NPI number — MR. ROBERT A GRAOR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAOR
Provider First Name:
ROBERT
Provider Middle Name:
A
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114926409
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/20/2006
NPI Reactivation Date:
03/27/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3865 EAST LOHMAN
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
LAS CRUCES
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88011-8292
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-532-5838
Provider Business Mailing Address Fax Number:
575-532-1778

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3865 EAST LOHMAN
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
LAS CRUCES
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88011-8292
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-532-5838
Provider Business Practice Location Address Fax Number:
575-532-1778
Provider Enumeration Date:
07/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  98-63 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 07230885 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 700521080 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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