Healthcare Provider Details

I. General information

NPI: 1063598506
Provider Name (Legal Business Name): PAMELA JOY GRABER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 05/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8503 NORTHTON GROVES BLVD
ODESSA FL
33556-1402
US

IV. Provider business mailing address

8503 NORTHTON GROVES BLVD
ODESSA FL
33556-1402
US

V. Phone/Fax

Practice location:
  • Phone: 859-684-5864
  • Fax:
Mailing address:
  • Phone: 859-684-5864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number24332
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: