MEDICARE: DIANA JOHNSTONE 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	OS6568	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1265524870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA JOHNSTONE GRAVES D.O.

Provider Business Mailing Address
First Line	:	2521 SE LAKE WEIR AVE
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34471-6722
Country	:	US
Telephone Number	:	352-690-6900
Fax Number	:	352-671-9525

Provider Business Practice Location Address
First Line	:	2521 SE LAKE WEIR AVE
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34471-6722
Country	:	US
Telephone Number	:	352-690-6900
Fax Number	:	352-671-9525

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

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	12/04/2023

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