Healthcare Provider Details

I. General information

NPI: 1992705768
Provider Name (Legal Business Name): NATHAN ADAM GRAVES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4534 W GATE BLVD STE 113
AUSTIN TX
78745-1470
US

IV. Provider business mailing address

125 S CLARK ST STE 900
CHICAGO IL
60603-4043
US

V. Phone/Fax

Practice location:
  • Phone: 512-394-6020
  • Fax: 512-350-2825
Mailing address:
  • Phone: 512-988-5355
  • Fax: 512-323-0307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM1116
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: