Individual
MATTHEW L GRAVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-6525
(601) 815-1722
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-6525
(601) 815-1722
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
18139
MS
207X00000X
Orthopaedic Surgery Physician
Primary
18139
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01301804
—
MS
05
—
106655
—
AL
05
—
1335061
—
LA
05
—
156441
—
AL
01
—
18139
MEDICAL LICENSE
MS
01
—
1891702148
NPI
MS
01
—
200000517
MEDICARE
MS
01
—
512G700003
UP MEDICARE
MS
01
—
512I200002
MEDICARE PTAN
MS
01
—
P00643807
UP RRMCR PTAN
MS
Enumeration date
08/01/2006
Last updated
02/12/2025
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