Provider Demographics
NPI:1114926409
Name:GRAOR, ROBERT A (MD)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:A
Last Name:GRAOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3865 EAST LOHMAN
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8292
Mailing Address - Country:US
Mailing Address - Phone:575-532-5838
Mailing Address - Fax:575-532-1778
Practice Address - Street 1:3865 EAST LOHMAN
Practice Address - Street 2:SUITE 4
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8292
Practice Address - Country:US
Practice Address - Phone:575-532-5838
Practice Address - Fax:575-532-1778
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2014-09-08
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
NM98-63207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM07230885Medicaid
NM700521080OtherMEDICARE GROUP NUMBER
F14169Medicare UPIN
NM347605405Medicare PIN
NM700521080OtherMEDICARE GROUP NUMBER