MEDICARE: DIANA J GRAVES DO LLC

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

General Provider Information

NPI Number	:	1578881645
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIANA J GRAVES DO LLC

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	:	OWNER
Name	:	DR. DIANA JOHNSTONE GRAVES
Credential	:	D.O.
Telephone Number	:	352-690-6900

Provider Enumeration Date	:	05/13/2010
Last Update Date	:	12/04/2023

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