Individual
DR. VAN A HARGRAVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5551 WINGHAVEN BLVD, SUITE 142, O FALLON, MO 63368-3617
(636) 695-2510
(636) 695-2512
Mailing address
315 MARTIN LUTHER KING JR WAY, SUITE 142, TACOMA, WA 98405-4234
(253) 530-8080
(253) 530-8099
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
107781
MO
207Q00000X
Family Medicine Physician
MD60598761
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080177925
RR MEDICARE
MO
Enumeration date
09/14/2005
Last updated
11/02/2016
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