Healthcare Provider Details

I. General information

NPI: 1073617296
Provider Name (Legal Business Name): RALPH J GRAFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3635 VISTA 3RD FL
ST LOUIS MO
63110
US

IV. Provider business mailing address

3691 RUTGER AVE PROVIDER ENROLLMENT
ST LOUIS MO
63110
US

V. Phone/Fax

Practice location:
  • Phone: 314-577-8566
  • Fax: 314-771-1945
Mailing address:
  • Phone: 314-977-4440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number26612
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: