Healthcare Provider Details

I. General information

NPI: 1750261707
Provider Name (Legal Business Name): GRAHAM MOUW, MD, PROFESSIONAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2025
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 ALTON RD APT 804
MIAMI BEACH FL
33139-6879
US

IV. Provider business mailing address

90 ALTON RD APT 804
MIAMI BEACH FL
33139-6879
US

V. Phone/Fax

Practice location:
  • Phone: 310-770-2489
  • Fax:
Mailing address:
  • Phone: 310-770-2489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GRAHAM MOUW
Title or Position: PRESIDENT
Credential: MD
Phone: 310-770-2489