Provider Demographics
NPI:1497771802
Name:LAGRAVE, MARK A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:LAGRAVE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4150 V ST
Mailing Address - Street 2:PSSB 2100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1460
Mailing Address - Country:US
Mailing Address - Phone:916-734-8571
Mailing Address - Fax:916-734-7950
Practice Address - Street 1:4150 V ST
Practice Address - Street 2:PSSB 2100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1460
Practice Address - Country:US
Practice Address - Phone:916-734-8571
Practice Address - Fax:916-734-7950
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2022-02-11
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Provider Licenses
StateLicense IDTaxonomies
CAA92383207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine