Provider Demographics
NPI:1063598506
Name:GRABER, PAMELA JOY (MD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:JOY
Last Name:GRABER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8503 NORTHTON GROVES BLVD
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-1402
Mailing Address - Country:US
Mailing Address - Phone:859-684-5864
Mailing Address - Fax:
Practice Address - Street 1:8503 NORTHTON GROVES BLVD
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-1402
Practice Address - Country:US
Practice Address - Phone:859-684-5864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24332207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine