Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 01047381 | IN |
NPI | 1417956756 |
---|---|
Provider Name | Dr. Starla D Graber |
First Address | Elkhart, IN 46514-1417 |
Second Address | Elkhart, IN 46514-1417 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 26/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000082177 | ANTHEM BLUE CROSS (01) | IN |
15431 | PHYSICIANS HEALTH PLAN (01) | IN |
200153620 | (05) | IN |
G59036 | (02) | IN |