MEDICARE: DR. JULIE DEAUN GRAVES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	D84791	MD
2	207Q00000X	Family Medicine Physician	G5110	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093794265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIE DEAUN GRAVES MD

Provider Business Mailing Address
First Line	:	212 DESOTO RD
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32080-7600
Country	:	US
Telephone Number	:	512-689-8001
Fax Number	:

Provider Business Practice Location Address
First Line	:	212 DESOTO RD
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32080-7600
Country	:	US
Telephone Number	:	512-689-8001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2006
Last Update Date	:	12/13/2025

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