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NPI Code Detail

MEDICARE: DR. DANIEL S GRAVES MD

MEDICARE: DR. DANIEL S GRAVES MD
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
12085R0202XDiagnostic Radiology PhysicianM-7920ID

General Provider Information

NPI Number : 1811955339
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DANIEL S GRAVES MD
Provider Business Mailing Address
First Line : 6977 N PENNCROSS WAY
Second Line :
City : MERIDIAN
State : ID
Zip : 83642-5184
Country : US
Telephone Number : 208-455-3732
Fax Number :
Provider Business Practice Location Address
First Line : 1717 ARLINGTON AVE
Second Line :
City : CALDWELL
State : ID
Zip : 83605-4802
Country : US
Telephone Number : 208-455-3732
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2006
Last Update Date : 07/08/2007

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