Healthcare Provider Details

I. General information

NPI: 1851541783
Provider Name (Legal Business Name): WALTER E GRAHAM MDPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2008
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 NORTHPARK DR
KINGWOOD TX
77339-1636
US

IV. Provider business mailing address

1331 NORTHPARK DR
KINGWOOD TX
77339-1636
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 TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberH4357
License Number StateTX

VIII. Authorized Official

Name: WALTER GRAHAM
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 281-359-5330