Healthcare Provider Details

I. General information

NPI: 1114926409
Provider Name (Legal Business Name): ROBERT A GRAOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 09/08/2014
Certification Date:
Deactivation Date: 03/20/2006
Reactivation Date: 03/27/2006

III. Provider practice location address

3865 EAST LOHMAN SUITE 4
LAS CRUCES NM
88011-8292
US

IV. Provider business mailing address

3865 EAST LOHMAN SUITE 4
LAS CRUCES NM
88011-8292
US

V. Phone/Fax

Practice location:
  • Phone: 575-532-5838
  • Fax: 575-532-1778
Mailing address:
  • Phone: 575-532-5838
  • Fax: 575-532-1778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number98-63
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: