Provider Demographics
NPI:1598855991
Name:GRAVES, DAVID M (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:M
Last Name:GRAVES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17491 N SADDLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-6411
Mailing Address - Country:US
Mailing Address - Phone:623-755-6922
Mailing Address - Fax:
Practice Address - Street 1:9060 E. VIA LINDA DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258
Practice Address - Country:US
Practice Address - Phone:480-500-2285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5121596-1206363A00000X
NE1289363A00000X
CO2043363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO61780839Medicaid
COCO300861Medicare PIN