Provider Demographics
NPI:1144220583
Name:GRAF, RONALD JOHN (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:JOHN
Last Name:GRAF
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 1:1901 S CEDAR ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2308
Mailing Address - Country:US
Mailing Address - Phone:253-627-9122
Mailing Address - Fax:253-272-7203
Practice Address - Street 1:1901 S CEDAR ST
Practice Address - Street 2:SUITE 205
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2308
Practice Address - Country:US
Practice Address - Phone:253-627-9122
Practice Address - Fax:253-272-7203
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00013532207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1395904Medicaid
WAA08421Medicare UPIN