Provider Demographics
NPI:1144408840
Name:RONALD J GRAF MD PS
Entity Type:Organization
Organization Name:RONALD J GRAF MD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRAF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-627-9122
Mailing Address - Street 1:1901 S CEDAR ST
Mailing Address - Street 2:#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:#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
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RONALD J GRAF MD PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-05
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00013532261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1395904Medicaid
WA1395904Medicaid