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NPI Code Detail

MEDICARE: DR. AUSTIN J. GRAHAM MD

MEDICARE: DR. AUSTIN J. GRAHAM MD
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
1207Q00000XFamily Medicine PhysicianM-9910ID

General Provider Information

NPI Number : 1548228844
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AUSTIN J. GRAHAM MD
Provider Business Mailing Address
First Line : 190 E BANNOCK ST
Second Line :
City : BOISE
State : ID
Zip : 83712-6241
Country : US
Telephone Number : 208-381-2222
Fax Number :
Provider Business Practice Location Address
First Line : 824 S DIAMOND ST
Second Line :
City : NAMPA
State : ID
Zip : 83686-5960
Country : US
Telephone Number : 208-463-7300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2006
Last Update Date : 01/23/2014

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