MEDICARE: STANLEY C GRAVES M D PC

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	174400000X	Specialist	22387	AZ

General Provider Information

NPI Number	:	1871692582
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STANLEY C GRAVES M D PC

Provider Business Mailing Address
First Line	:	3104 E CAMELBACK RD # 1003
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4502
Country	:	US
Telephone Number	:	602-952-8111
Fax Number	:	602-952-1572

Provider Business Practice Location Address
First Line	:	5080 N 40TH ST STE 103
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-2158
Country	:	US
Telephone Number	:	602-952-8111
Fax Number	:	602-952-1572

Authorized Official
Title or Position	:	OWNER
Name	:	STANLEY CECIL GRAVES
Credential	:	M.D.
Telephone Number	:	602-952-8111

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	02/04/2021

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