Healthcare Provider Details

I. General information

NPI: 1356339048
Provider Name (Legal Business Name): NELSON VERE GRAHAM JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 03/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 SAINT MARYS DR SUITE 201 EAST
EVANSVILLE IN
47714-0511
US

IV. Provider business mailing address

801 SAINT MARYS DR SUITE 201 EAST
EVANSVILLE IN
47714-0511
US

V. Phone/Fax

Practice location:
  • Phone: 812-475-8975
  • Fax: 812-471-8322
Mailing address:
  • Phone: 812-475-8975
  • Fax: 812-471-8322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01025814A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: