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General NPI Number Information
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NPI Number | 1033198619
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Entity Type | Individual
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Provider Name | STEPHEN C. GRAVES M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/12/2006
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Last Update Date | 04/20/2011
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Provider Practice Location Address
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Address Line | EAST MAIN & SOUTH 20TH STREET
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City | VAN BUREN
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State | AR
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Zip | 72957
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Country | US
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Telephone | 479-474-3401
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Fax | 479-471-4388
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Provider Business Mailing Address
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Address Line | 18167 US HIGHWAY 19 N SUITE 650
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City | CLEARWATER
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State | FL
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Zip | 33764-3528
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Country | US
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Telephone | 800-507-8874
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Fax | 727-536-2896
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | R-2330
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License Number State | AR
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