| NPI | 1992736672 |
|---|---|
| Professional Name | JOHNNIE R DEGRAW |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME0048978) |
| Additional Taxonomies | 261QR1300X Clinic/Center Rural Health (Licence: FL 108911) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2020-10-01 |