Provider Demographics
NPI:1255365839
Name:GRAVES, DANIEL LEAHY (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:LEAHY
Last Name:GRAVES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:17900 TALBOT RD S,
Mailing Address - Street 2:#101
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-8242
Mailing Address - Country:US
Mailing Address - Phone:425-235-9614
Mailing Address - Fax:425-235-1060
Practice Address - Street 1:17900 TALBOT RD S
Practice Address - Street 2:#101
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-8212
Practice Address - Country:US
Practice Address - Phone:425-235-9614
Practice Address - Fax:425-235-1060
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2012-10-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WA17917173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1620509Medicaid
WAA04587Medicare UPIN
WA1620509Medicaid