Provider Demographics
NPI:1821044272
Name:GRAVES, OLIVIA MARGO (MD)
Entity Type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:MARGO
Last Name:GRAVES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9765 SW 184TH ST
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-6932
Mailing Address - Country:US
Mailing Address - Phone:305-255-3950
Mailing Address - Fax:305-233-2503
Practice Address - Street 1:9765 SW 184TH ST
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-6932
Practice Address - Country:US
Practice Address - Phone:305-255-3950
Practice Address - Fax:305-233-2503
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME27434207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL036667600Medicaid
FL92962Medicare ID - Type Unspecified
FL036667600Medicaid