Healthcare Provider Details

I. General information

NPI: 1285863423
Provider Name (Legal Business Name): JOSEPH SCOTT GRAVES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 N SPRING ST STE A
HARRISON AR
72601-2913
US

IV. Provider business mailing address

1423 N JEFFERSON AVE STE A100
SPRINGFIELD MO
65802-1917
US

V. Phone/Fax

Practice location:
  • Phone: 708-365-0850
  • Fax: 870-365-0862
Mailing address:
  • Phone: 417-269-8817
  • Fax: 417-269-8744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2009012446
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: