Healthcare Provider Details

I. General information

NPI: 1720034804
Provider Name (Legal Business Name): CHESTER F GRAHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 CENTRAL EXPY N SUITE 360
ALLEN TX
75013-6103
US

IV. Provider business mailing address

3600 GASTON AVE SUITE 1205
DALLAS TX
75246-1800
US

V. Phone/Fax

Practice location:
  • Phone: 214-691-1902
  • Fax: 214-987-1845
Mailing address:
  • Phone: 214-692-8262
  • Fax: 214-696-4190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberH9214
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: