Basic Information
| Provider Information | |||||||||
| NPI: | 1780865824 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRAVES | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 933 ALPINE AVE | ||||||||
| Address2: | |||||||||
| City: | BOULDER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 803043305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034492730 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4740 PEARL PKWY STE 200 | ||||||||
| Address2: | |||||||||
| City: | BOULDER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 803013080 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034492730 | ||||||||
| FaxNumber: | 3034495821 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | 363A00000X | PA0004283 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | AP2447 | MA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.