Provider Demographics
NPI:1043346570
Name:GRAPER, ROBERT GORDON (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:GORDON
Last Name:GRAPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2915 COLTSGATE RD
Mailing Address - Street 2:STE 103
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211
Mailing Address - Country:US
Mailing Address - Phone:704-375-7111
Mailing Address - Fax:704-375-0444
Practice Address - Street 1:2915 COLTSGATE RD
Practice Address - Street 2:STE 103
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211
Practice Address - Country:US
Practice Address - Phone:704-375-7111
Practice Address - Fax:704-375-0444
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC336692086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7936801Medicaid
2142544CMedicare ID - Type Unspecified
NC7936801Medicaid