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General NPI Number Information
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NPI Number | 1942301775
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Entity Type | Individual
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Provider Name | RICAARD TYSON GRAF PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 13000 BRUCE B DOWNS BLVD JAMES A HALEY VA HOSPITAL
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City | TAMPA
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State | FL
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Zip | 33612
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Country | US
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Telephone | 813-972-2000
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Fax | 813-978-5936
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Provider Business Mailing Address
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Address Line | 36750 EICANO BLVD #6
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City | ZEPHYRHILLS
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State | FL
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Zip | 33542
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Country | US
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Telephone | 813-780-7805
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State | MI
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