Individual
ANGELA GRAEBER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-2538
(601) 815-1854
Mailing address
2500 N STATE STREET, JACKSON, MS 39216
(601) 984-2538
(601) 815-1854
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
11360
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08603769
—
MS
05
—
1025429
—
LA
05
—
157418
—
AL
01
—
P00436435
RAILROAD MEDICARE
MS
01
—
P004622007
RAILROAD MEDICARE
MS
01
—
P01168130
RR MEDICARE PTAN
MS
Enumeration date
05/29/2007
Last updated
04/01/2014
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