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NPI Code Detail

MEDICARE: BOBBY L GRAHAM JR. M.D.

MEDICARE: BOBBY L GRAHAM JR. 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
1207RX0202XMedical Oncology Physician10277MS
2207RH0002XHospice and Palliative Medicine (Internal Medicine) Physician10277MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14225962OTHERAETNA HEALTHCARE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205831666
Entity Type Code : Individual
Provider Name (Legal Business Name) : BOBBY L GRAHAM JR. M.D.
Provider Business Mailing Address
First Line : 5959 S SHERWOOD FOREST BLVD
Second Line :
City : BATON ROUGE
State : LA
Zip : 70816-6038
Country : US
Telephone Number : 601-200-5900
Fax Number : 225-765-5727
Provider Business Practice Location Address
First Line : 969 LAKELAND DR
Second Line :
City : JACKSON
State : MS
Zip : 39216-4606
Country : US
Telephone Number : 601-200-5900
Fax Number : 601-200-5959
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2005
Last Update Date : 08/19/2025

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