MEDICARE: RICHARD HENRY GRAVES III D.P.M.

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	213ES0000X	Sports Medicine Podiatrist	E3954	CA
2	213E00000X	Podiatrist	E3954	CA
3	213ES0103X	Foot & Ankle Surgery Podiatrist	E-3954	CA

General Provider Information

NPI Number	:	1912975434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD HENRY GRAVES III D.P.M.

Provider Business Mailing Address
First Line	:	304 CHERRY AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-3848
Country	:	US
Telephone Number	:	562-433-0478
Fax Number	:	562-438-3690

Provider Business Practice Location Address
First Line	:	304 CHERRY AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-3848
Country	:	US
Telephone Number	:	562-433-0478
Fax Number	:	562-438-3690

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

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	02/08/2016

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