Healthcare Provider Details

I. General information

NPI: 1194933671
Provider Name (Legal Business Name): BOBBIE GERALD GRAVES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6315 THIRD ST
SAN FRANCISCO CA
94124
US

IV. Provider business mailing address

330 SUMMIT ST
SAN FRANCISCO CA
94112-3000
US

V. Phone/Fax

Practice location:
  • Phone: 415-467-3880
  • Fax:
Mailing address:
  • Phone: 415-467-3880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC-358470
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: