Individual
CLARENCE RICHARD GRAVES III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
509 SE RIVERSIDE DR, SUITE 203, STUART, FL 34994-2579
(772) 288-5862
(772) 288-5874
Mailing address
PO BOX 417, STUART, FL 34995-0417
(772) 223-2832
(772) 223-5646
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9106480
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004802000
—
FL
01
—
Y0C06
FLORIDA BLUE
FL
Enumeration date
06/24/2005
Last updated
10/09/2020
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