Provider Demographics
NPI:1922077577
Name:GRAZER, JON MARTEL (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:MARTEL
Last Name:GRAZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 NEWPORT CENTER DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7601
Mailing Address - Country:US
Mailing Address - Phone:949-644-1240
Mailing Address - Fax:949-644-9274
Practice Address - Street 1:400 NEWPORT CENTER DR
Practice Address - Street 2:SUITE 302
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7601
Practice Address - Country:US
Practice Address - Phone:949-644-1240
Practice Address - Fax:949-644-9274
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55421208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG60775Medicare UPIN
CAA55421Medicare ID - Type Unspecified