Healthcare Provider Details

I. General information

NPI: 1750636320
Provider Name (Legal Business Name): IAN JASON MORGAN-GRAHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2012
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4675 28TH CT
VERO BEACH FL
32967-1329
US

IV. Provider business mailing address

1555 INDIAN RIVER BLVD STE B210
VERO BEACH FL
32960-7113
US

V. Phone/Fax

Practice location:
  • Phone: 772-257-8224
  • Fax: 772-252-3245
Mailing address:
  • Phone: 772-257-8224
  • Fax: 772-252-3245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME120532
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: