Graves, Blane A
Graves, Blane A is an individual health care provider with primary practice located at 1408 College Dr , Texarkana TX 75503-3534. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Graves, Blane A can be contacted via phone (903) 794-0515.Contact Information
Primary practice address
1408 College Dr
Texarkana TX 75503-3534
Phone: (903) 794-0515
Fax: (903) 793-8000
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | L4402 | Texas |
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | E2697 | Arkansas |
Profile Details
| NPI number | 1124010301 |
|---|---|
| LBN Legal business name | Graves, Blane A |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 16th, 2005 |
| Last updated | Sep 24th, 2013 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1124010301 | NPPES |
| Texas | MEDICAID | 152744201 | |
| Texas | Other | 430909809 | |
| Texas | Other | 5L641 | |
| Texas | Other | 8K1368 | |
| Texas | Other | 020900066-00 | |
| Texas | Other | 080189370 | |
| Texas | MEDICAID | 142180001 |
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