Organization
MARANATHA MEDICAL CLINIC INC P S
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAN L GRAV ES MD (PRESIDENT)
(425) 235-9614
Entity
Organization
Contact information
Practice address
17900 TALBOT RD S, #101, RENTON, WA 98055-8212
(425) 235-9614
(425) 235-1060
Mailing address
17900 TALBOT RD S, #101, RENTON, WA 98055-8212
(425) 235-9614
(425) 235-1060
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
17917
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1620509
—
WA
Enumeration date
11/23/2009
Last updated
09/11/2017
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