Graves, Clarence Richard

Graves, Clarence Richard is an individual health care provider with primary practice located at 509 Se Riverside Dr Suite 203, Stuart FL 34994-2579. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Graves, Clarence Richard can be contacted via phone (772) 288-5862.

Contact Information

Primary practice address
509 Se Riverside Dr Suite 203 Stuart FL 34994-2579
Phone: (772) 288-5862
Fax: (772) 288-5874
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA9106480 Florida

Profile Details

NPI number 1568468437
LBN Legal business name Graves, Clarence Richard
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 24th, 2005
Last updated Oct 9th, 2020 - about 5 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1568468437 NPPES
Florida Other Y0C06 FLORIDA BLUE
Florida MEDICAID 004802000 FLORIDA BLUE

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