Provider Demographics
NPI:1356321772
Name:MONETT INTERNAL MEDICINE LLC
Entity Type:Organization
Organization Name:MONETT INTERNAL MEDICINE LLC
Other - Org Name:ROBERT L GRAVES DO
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT PYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:417-235-3200
Mailing Address - Street 1:527 E CLEVELAND
Mailing Address - Street 2:
Mailing Address - City:MONETT
Mailing Address - State:MO
Mailing Address - Zip Code:65708
Mailing Address - Country:US
Mailing Address - Phone:417-235-3200
Mailing Address - Fax:417-235-3220
Practice Address - Street 1:527 E CLEVELAND
Practice Address - Street 2:
Practice Address - City:MONETT
Practice Address - State:MO
Practice Address - Zip Code:65708
Practice Address - Country:US
Practice Address - Phone:417-235-3200
Practice Address - Fax:417-235-3220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1K11207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E73703Medicare UPIN