Provider Demographics
NPI:1881882496
Name:ROBERT A GRAOR, M.D.
Entity type:Organization
Organization Name:ROBERT A GRAOR, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:GRAOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-527-9977
Mailing Address - Street 1:PO BOX 291887
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-0887
Mailing Address - Country:US
Mailing Address - Phone:800-350-0322
Mailing Address - Fax:937-534-0166
Practice Address - Street 1:1515 S 8TH ST
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-4940
Practice Address - Country:US
Practice Address - Phone:505-544-0790
Practice Address - Fax:505-527-9199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM700521080Medicare PIN