Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 10714 | OR |
NPI | 1215129911 |
---|---|
Provider Name | Mr. Stacy Lee Graves |
First Address | Eugene, OR 97404 |
Second Address | Eugene, OR 97401-4093 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2007 |
Last Update Date | 16/08/2007 |