Provider Demographics
NPI:1225674260
Name:RICHARD H GRAVES DPM INC
Entity Type:Organization
Organization Name:RICHARD H GRAVES DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:III
Authorized Official - Credentials:DPM
Authorized Official - Phone:562-433-0478
Mailing Address - Street 1:304 CHERRY AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-3848
Mailing Address - Country:US
Mailing Address - Phone:562-433-0478
Mailing Address - Fax:
Practice Address - Street 1:2333 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-3025
Practice Address - Country:US
Practice Address - Phone:562-426-5151
Practice Address - Fax:562-438-3690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty