Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | R2F62 | MO |
Y | 207XS0117X | Orthopaedic Spine Surgeon | R2F62 | MO |
NPI | 1417015827 |
---|---|
Provider Name | Timothy G Graven |
First Address | Saint Peters, MO 63376-0008 |
Second Address | Saint Peters, MO 63376-1690 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 04/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C52049 | (02) | MO |