Provider Demographics
NPI:1932376142
Name:GRAVES, RICHARD E
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:E
Last Name:GRAVES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3265 TEAL RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-2264
Mailing Address - Country:US
Mailing Address - Phone:765-477-1234
Mailing Address - Fax:765-477-2345
Practice Address - Street 1:3265 TEAL RD
Practice Address - Street 2:SUITE 2
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-2264
Practice Address - Country:US
Practice Address - Phone:765-477-1234
Practice Address - Fax:765-477-2345
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN651212394/0344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi