Healthcare Provider Details

I. General information

NPI: 1548261381
Provider Name (Legal Business Name): DEBRA A. GRAHAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 03/07/2023
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3585 BROADWAY ST
NORTH BEND OR
97459-1251
US

IV. Provider business mailing address

3585 BROADWAY AVE
NORTH BEND OR
97459-1251
US

V. Phone/Fax

Practice location:
  • Phone: 541-756-2584
  • Fax: 541-756-5783
Mailing address:
  • Phone: 541-756-2584
  • Fax: 541-756-5783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD20364
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: