Provider Demographics
NPI:1578881645
Name:DIANA J GRAVES DO LLC
Entity Type:Organization
Organization Name:DIANA J GRAVES DO LLC
Other - Org Name:.DIANA J. GRAVES, D.O.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:JOHNSTONE
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:352-690-6900
Mailing Address - Street 1:2521 SE LAKE WEIR AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-6722
Mailing Address - Country:US
Mailing Address - Phone:352-690-6900
Mailing Address - Fax:352-671-9525
Practice Address - Street 1:2521 SE LAKE WEIR AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6722
Practice Address - Country:US
Practice Address - Phone:352-690-6900
Practice Address - Fax:352-671-9525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-13
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty