Provider Demographics
NPI:1538271507
Name:GRAEVE, JONATHAN P (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:P
Last Name:GRAEVE
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:PO BOX 35100
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59107-5100
Mailing Address - Country:US
Mailing Address - Phone:406-238-2500
Mailing Address - Fax:
Practice Address - Street 1:2800 10TH AVE N
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0703
Practice Address - Country:US
Practice Address - Phone:406-238-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT95642085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT8HZN27OtherMEDICARE PRYOR
MT0027608OtherMDCD PIN
MT8HZ79QOtherMEDICARE LG
MT000092761OtherBCBS PIN
MT8HZN64OtherMEDICARE CROW
MTG67414Medicare UPIN
MT8HZN27OtherMEDICARE PRYOR
MT000081629Medicare PIN
MT000081630Medicare PIN