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General NPI Number Information
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NPI Number | 1770596884
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Entity Type | Organization
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Legal Business Name | WARRENTON FAMILY MEDICINE LLC
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 11/30/2007
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Provider Practice Location Address
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Address Line | 605 E BOONESLICK RD SUITE ONE
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City | WARRENTON
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State | MO
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Zip | 63383-2127
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Country | US
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Telephone | 636-456-1448
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Fax | 636-456-9093
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Provider Business Mailing Address
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Address Line | 605 E BOONESLICK RD SUITE ONE
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City | WARRENTON
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State | MO
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Zip | 63383-2127
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Country | US
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Telephone | 636-456-1448
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Fax | 636-456-9093
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. CHRISTOPHER GENE GRAVES
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Credential | DO
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Telephone | 636-456-1448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 2005019582
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License Number State | MO
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