Basic Information
| Provider Information | |||||||||
| NPI: | 1063465995 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRABER | ||||||||
| FirstName: | TERRY | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 353 FAIRMONT BLVD | ||||||||
| Address2: | ATTEN MEDICAL STAFF SERVICES | ||||||||
| City: | RAPID CITY | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577016000 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1041 MONTGOMERY STREET | ||||||||
| Address2: | |||||||||
| City: | CUSTER | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577301304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6056734150 | ||||||||
| FaxNumber: | 6056733917 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 01/23/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 3475 | SD | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.