MEDICARE: DR. DOUGLAS T 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
1	207L00000X	Anesthesiology Physician	35-084765	OH
2	207L00000X	Anesthesiology Physician	M7227	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	P00412474	OTHER	OH	MEDICARE RAILROAD
7	P00212694	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000225207	OTHER	OH	UNISON
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	7825578	OTHER	OH	AETNA
8	0583328	OTHER	OH	BCMH

General Provider Information

NPI Number	:	1811919194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS T GRAHAM MD

Provider Business Mailing Address
First Line	:	2811 DEL CURTO RD UNIT B
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-4981
Country	:	US
Telephone Number	:	330-518-8899
Fax Number	:

Provider Business Practice Location Address
First Line	:	2811 DEL CURTO RD UNIT B
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-4981
Country	:	US
Telephone Number	:	330-518-8899
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	05/24/2023

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Directions to “ DR. DOUGLAS T GRAHAM MD” Practice Location

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