Provider Demographics
NPI:1063465995
Name:GRABER, TERRY M (MD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:M
Last Name:GRABER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:353 FAIRMONT BLVD
Mailing Address - Street 2:ATTEN MEDICAL STAFF SERVICES
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-6000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1041 MONTGOMERY STREET
Practice Address - Street 2:
Practice Address - City:CUSTER
Practice Address - State:SD
Practice Address - Zip Code:57730-1304
Practice Address - Country:US
Practice Address - Phone:605-673-4150
Practice Address - Fax:605-673-3917
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD3475207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E96936Medicare UPIN