Basic Information
| Provider Information | |||||||||
| NPI: | 1588624852 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCGRAW | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | PATRICK | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 E CALIFORNIA BLVD | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911053205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 0089820208 | ||||||||
| FaxNumber: | 8448973788 | ||||||||
| Practice Location | |||||||||
| Address1: | 5565 GROSSMONT CENTER DR STE 551 | ||||||||
| Address2: | |||||||||
| City: | LA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919423078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008982020 | ||||||||
| FaxNumber: | 8448973788 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2006 | ||||||||
| LastUpdateDate: | 03/19/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | MD068046L | PA | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | A155228 | CA | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 001748034 | 05 | PA | MEDICAID | 1760541569 | 05 | CA | MEDICAID |