Provider Demographics
NPI:1215598271
Name:GRAVES, JONAH MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JONAH
Middle Name:MICHAEL
Last Name:GRAVES
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Gender:M
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:CB 8121
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-5060
Mailing Address - Fax:314-996-8436
Practice Address - Street 1:1 BARNES JEWISH HOSPITAL PLZ
Practice Address - Street 2:DIV IM GENERAL MED
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1003
Practice Address - Country:US
Practice Address - Phone:314-747-3000
Practice Address - Fax:314-996-8436
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2022-07-20
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Provider Licenses
StateLicense IDTaxonomies
MO2022008396207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200073283Medicaid