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General NPI Number Information
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NPI Number | 1053742262
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Entity Type | Individual
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Provider Name | KERRY MULVEY GRAEBE M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/13/2013
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 333 N SANTA ROSA
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City | SAN ANTONIO
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State | TX
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Zip | 78207-3108
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Country | US
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Telephone | 210-704-3030
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Fax |
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Provider Business Mailing Address
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Address Line | 100 MADISON AVE SUITE 311
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City | MORRISTOWN
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State | NJ
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Zip | 07960-6136
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Country | US
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Telephone | 973-971-9950
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Fax |
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 25MA09415400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | S6625
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License Number State | TX
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