Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 9829 | MT |
NPI | 1134156276 |
---|---|
Provider Name | Walter G Graves |
First Address | Kalispell, MT 59901-3167 |
Second Address | Kalispell, MT 59901-3167 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 13/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000083673 | (02) | MT |
0066827 | (05) | MT |
C34687 | (02) | MT |