Graves, Glen Robert

Graves, Glen Robert is an individual health care provider with primary practice located at 2500 N State St , Jackson MS 39216-4500. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neonatal-Perinatal Medicine, which is considered as his primary health care specialty. Graves, Glen Robert can be contacted via phone (601) 815-7100.

Contact Information

Primary practice address
2500 N State St Jackson MS 39216-4500
Phone: (601) 815-7100
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neonatal-Perinatal Medicine 2080N0001X 05989 Mississippi

Profile Details

NPI number 1407883234
LBN Legal business name Graves, Glen Robert
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 27th, 2006
Last updated Jun 27th, 2012 - 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407883234 NPPES
Louisiana MEDICAID 1969265
Louisiana MEDICAID 00017226

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