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General NPI Number Information
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NPI Number | 1306983556
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Entity Type | Individual
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Provider Name | RYAN HARGRAVES M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 10/17/2025
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Provider Practice Location Address
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Address Line | 200 4TH AVE W
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City | GRINNELL
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State | IA
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Zip | 50112-1833
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Country | US
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Telephone | 985-445-7750
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Fax |
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Provider Business Mailing Address
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Address Line | 1021 W OAKLAND AVE STE 310
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City | JOHNSON CITY
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State | TN
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Zip | 37604-2192
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Country | US
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Telephone | 423-302-6565
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | CDRH.0061469
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD218811
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 66431
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD61352749
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License Number State | WA
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Taxonomy #5
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0101277092
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License Number State | VA
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Taxonomy #6
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 218146
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License Number State | AK
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Taxonomy #7
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD-52284
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License Number State | IA
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