MEDICARE: DR. GRETCHEN DENISE GRAVES 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
1	208000000X	Pediatrics Physician	G46185	CA

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	:	1306862040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRETCHEN DENISE GRAVES M.D.

Provider Business Mailing Address
First Line	:	2260 GLADSTONE DR
Second Line	:	SUITE 2
City	:	PITTSBURG
State	:	CA
Zip	:	94565-5125
Country	:	US
Telephone Number	:	925-427-0391
Fax Number	:	925-427-6797

Provider Business Practice Location Address
First Line	:	2260 GLADSTONE DR
Second Line	:	SUITE 2
City	:	PITTSBURG
State	:	CA
Zip	:	94565-5125
Country	:	US
Telephone Number	:	925-427-0391
Fax Number	:	925-427-6797

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	05/14/2013

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