Healthcare Provider Details

I. General information

NPI: 1215929732
Provider Name (Legal Business Name): CHRISTOPHER GENE GRAVES D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 03/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 E BOONESLICK RD SUITE ONE
WARRENTON MO
63383-2127
US

IV. Provider business mailing address

605 E BOONESLICK RD SUITE ONE
WARRENTON MO
63383-2127
US

V. Phone/Fax

Practice location:
  • Phone: 636-456-1448
  • Fax: 636-456-9093
Mailing address:
  • Phone: 636-456-1448
  • Fax: 636-456-9093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2005019582
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: