MEDICARE: DR. CHRISTOPHER GENE GRAVES D.O.

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
1	207Q00000X	Family Medicine Physician	2005019582	MO

General Provider Information

NPI Number	:	1215929732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER GENE GRAVES D.O.

Provider Business Mailing Address
First Line	:	605 E BOONESLICK RD
Second Line	:	SUITE ONE
City	:	WARRENTON
State	:	MO
Zip	:	63383-2127
Country	:	US
Telephone Number	:	636-456-1448
Fax Number	:	636-456-9093

Provider Business Practice Location Address
First Line	:	605 E BOONESLICK RD
Second Line	:	SUITE ONE
City	:	WARRENTON
State	:	MO
Zip	:	63383-2127
Country	:	US
Telephone Number	:	636-456-1448
Fax Number	:	636-456-9093

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	03/24/2009

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