Provider Demographics
NPI:1912343179
Name:GRAVES, MARTIN WA (B SC, MBBS)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:WA
Last Name:GRAVES
Suffix:
Gender:M
Credentials:B SC, MBBS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4150 V STREET PSSB SUITE 1200
Mailing Address - Street 2:UCDMC DEPT. OF ANESTHESIOLOGY & PAIN MED
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817
Mailing Address - Country:US
Mailing Address - Phone:916-734-5028
Mailing Address - Fax:916-734-2975
Practice Address - Street 1:4150 V STREET PSSB SUITE 1200
Practice Address - Street 2:UCDMC DEPT. OF ANESTHESIOLOGY & PAIN MED
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817
Practice Address - Country:US
Practice Address - Phone:916-734-5028
Practice Address - Fax:916-734-2975
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF 5766207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF 5766OtherMD LICENSE 2113