RONALD J GRAF MD PS - NPI NUMBER 1144408840

Summary

Provider Name: RONALD J GRAF MD PS

NPI Number: 1144408840

Clasification: Clinic/Center (261QM2500X)

Specialization: Medical Specialty

Address:
1901 S CEDAR ST
#205
TACOMA, WA
ZIP 98405

Phone Number: (253) 627-9122



Detailed Information

RONALD J GRAF MD PS is a medical specialty clinic/center in Tacoma, WA. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). The assigned NPI number for this provider is 1144408840 and is registered as an organization entity type.

The provider's business address is:

1901 S CEDAR ST
#205
TACOMA, WA
ZIP 98405-308
Phone: (253) 627-9122
Fax: (253) 272-7203

The provider's authorized official is Ronald J Graf .
The authorized official title is President and has the following contact phone number (253) 627-9122.

The enumeration date for this NPI number is 2/5/2008 and was last updated on 2/25/2008.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 261QM2500X Clinic/Center Medical Specialty MD00013532 WA Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 A08421 MEDICARE UPIN WA
2 1395904 MEDICAID WA

NPI Record

No. Field Name Field Value
1 NPI 1144408840
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name RONALD J GRAF MD PS
5 Provider First Line Business Practice Location Address 1901 S CEDAR ST
6 Provider Second Line Business Practice Location Address #205
7 Provider Business Practice Location Address City Name TACOMA
8 Provider Business Practice Location Address State Name WA
9 Provider Business Practice Location Address Postal Code 984052308
10 Provider Business Practice Location Address Country Code If outside U S US
11 Provider Business Practice Location Address Telephone Number 2536279122
12 Provider Business Practice Location Address Fax Number 2532727203
13 Provider Enumeration Date 2/5/2008
14 Last Update Date 2/25/2008
15 Authorized Official Last Name GRAF
16 Authorized Official First Name RONALD
17 Authorized Official Middle Name J
18 Authorized Official Title or Position PRESIDENT
19 Authorized Official Telephone Number 2536279122
20 Healthcare Provider Taxonomy Code 1 261QM2500X
21 Provider License Number 1 MD00013532
22 Provider License Number State Code 1 WA
23 Healthcare Provider Primary Taxonomy Switch 1 Y
24 Other Provider Identifier 1 A08421
25 Other Provider Identifier Type Code 1 02
26 Other Provider Identifier State 1 WA
27 Other Provider Identifier 2 1395904
28 Other Provider Identifier Type Code 2 05
29 Other Provider Identifier State 2 WA
30 Is Organization Subpart Y
31 Parent Organization LBN RONALD J GRAF MD PS
32 Parent Organization TIN
33 Authorized Official Name Prefix Text DR.
34 Authorized Official Credential Text M.D.

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This page was last updated on: 11/14/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.