Provider Demographics
NPI:1265524870
Name:GRAVES, DIANA JOHNSTONE (DO)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:JOHNSTONE
Last Name:GRAVES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6568207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372308900Medicaid
FL80766Medicare ID - Type Unspecified