Healthcare Provider Details

I. General information

NPI: 1164691366
Provider Name (Legal Business Name): CHRISTINE DAWN GRAHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 N LA CHOLLA BLVD
TUCSON AZ
85741-4201
US

IV. Provider business mailing address

7600 N LA CHOLLA BLVD
TUCSON AZ
85741-4201
US

V. Phone/Fax

Practice location:
  • Phone: 520-751-3675
  • Fax: 520-547-5767
Mailing address:
  • Phone: 520-751-3675
  • Fax: 520-547-5767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number41222
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: