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NPI Code Detail

MEDICARE: DR. CHARLES E. GRAHAM M.D.

MEDICARE:  DR. CHARLES E. GRAHAM  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207W00000XOphthalmology Physician6794NV
2207W00000XOphthalmology Physician21459AZ
3207W00000XOphthalmology Physician22808KS

General Provider Information

NPI Number : 1134270390
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES E. GRAHAM M.D.
Provider Business Mailing Address
First Line : PO BOX 34405
Second Line : 3435 W. CRAIG RD. SUITE A
City : LAS VEGAS
State : NV
Zip : 89133-4405
Country : US
Telephone Number : 702-733-6673
Fax Number :
Provider Business Practice Location Address
First Line : 3435 W CRAIG RD STE A
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89032-5116
Country : US
Telephone Number : 702-733-6673
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2007
Last Update Date : 07/08/2007

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