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General NPI Number Information
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NPI Number | 1720210289
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Entity Type | Organization
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Legal Business Name | LANCE E.GRAVELY, M.D., INC.
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Dates
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Enumeration Date | 08/18/2009
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Last Update Date | 03/09/2011
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Provider Practice Location Address
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Address Line | 1700 E. CESAR CHAVEZ AVENUE SUITE 3750
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City | LOS ANGELES
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State | CA
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Zip | 90033-2424
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Country | US
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Telephone | 323-221-1302
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Fax | 323-221-1502
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Provider Business Mailing Address
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Address Line | 1700 E. CESAR CHAVEZ AVE. SUITE 3750
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City | LOS ANGELES
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State | CA
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Zip | 90033-2424
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Country | US
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Telephone | 323-221-1302
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Fax | 323-221-1502
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. LANCE EUGENE GRAVELY
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Credential | M.D.
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Telephone | 323-221-1302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | A87871
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License Number State | CA
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