Healthcare Provider Details

I. General information

NPI: 1437359056
Provider Name (Legal Business Name): JOSEPH MARK GRAHAM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2007
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 HEALTH PARK BLVD
ST AUGUSTINE FL
32086-3701
US

IV. Provider business mailing address

PO BOX 112727
GAINESVILLE FL
32611-2727
US

V. Phone/Fax

Practice location:
  • Phone: 888-481-2135
  • Fax: 386-627-7319
Mailing address:
  • Phone: 352-273-7002
  • Fax: 352-273-7388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberOS11534
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOS11534
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: