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NPI Code Detail

MEDICARE: DR. WHITE SOLOMON GRAVES IV M.D.

MEDICARE: DR. WHITE SOLOMON GRAVES IV M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207XX0005XSports Medicine (Orthopaedic Surgery) Physician14205RLA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1194700021
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WHITE SOLOMON GRAVES IV M.D.
Provider Business Mailing Address
First Line : 1501 LOUISVILLE AVE
Second Line :
City : MONROE
State : LA
Zip : 71201-6025
Country : US
Telephone Number : 318-323-8451
Fax Number : 318-361-2613
Provider Business Practice Location Address
First Line : 1501 LOUISVILLE AVE
Second Line :
City : MONROE
State : LA
Zip : 71201-6025
Country : US
Telephone Number : 318-323-8451
Fax Number : 318-361-2613
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2005
Last Update Date : 01/10/2014

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