Individual
DR. BLANE A GRAVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1408 COLLEGE DR, TEXARKANA, TX 75503-3534
(903) 794-0515
(903) 793-8000
Mailing address
5002 COWHORN CREEK RD, TEXARKANA, TX 75503-9766
(903) 614-3000
(903) 614-3525
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
E2697
AR
207Q00000X
Family Medicine Physician
Primary
L4402
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020900066-00
QUALCHOICE
TX
01
—
080189370
RAILROAD MEDICARE
TX
05
—
142180001
—
AR
05
—
152744201
—
TX
01
—
430909809
NOVASYS
TX
01
—
5L641
ARKANSAS BLUE CROSS BLUE SHIELD
TX
01
—
8K1368
TEXAS BLUE CROSS BLUE SHIELD
TX
Enumeration date
08/16/2005
Last updated
09/24/2013
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