Healthcare Provider Details

I. General information

NPI: 1902880529
Provider Name (Legal Business Name): WALTER E GRAHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 NORTH PARK DRIVE
KINGWOOD TX
77339
US

IV. Provider business mailing address

1331 NORTH PARK DRIVE
KINGWOOD TX
77339
US

V. Phone/Fax

Practice location:
  • Phone: 281-359-5330
  • Fax: 281-359-6117
Mailing address:
  • Phone: 281-359-5330
  • Fax: 281-359-6117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD.15564R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberH4357
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number29172
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberH4357
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH4357
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: