Provider Demographics
NPI:1174560577
Name:GRAVES, MARK S (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:GRAVES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:M
Other - Middle Name:STEVEN
Other - Last Name:GRAVES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1235 NE LOOP 286
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-2226
Mailing Address - Country:US
Mailing Address - Phone:903-785-4166
Mailing Address - Fax:903-785-4172
Practice Address - Street 1:1235 NE LOOP 286
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-2226
Practice Address - Country:US
Practice Address - Phone:903-785-4166
Practice Address - Fax:903-785-4172
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5664207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122646602Medicaid
TX80V361Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
TXE20042Medicare UPIN