Graves, Jackson

Graves, Jackson is an sole proprietor health care provider with primary practice located at 530 Ne Glen Oak Ave , Peoria IL 61637-0001. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Pediatrics is his primary health care specialty. Graves, Jackson can be contacted via phone (309) 655-2000.

Contact Information

Primary practice address
530 Ne Glen Oak Ave Peoria IL 61637-0001
Phone: (309) 655-2000
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 036.162138 Illinois
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 036.162138 Illinois

Profile Details

NPI number 1740843127
LBN Legal business name Graves, Jackson
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 21st, 2019
Last updated Feb 28th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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