Healthcare Provider Details

I. General information

NPI: 1487667473
Provider Name (Legal Business Name): WILLIAM T GRAFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 S 400 E STE 101
ST GEORGE UT
84770-3765
US

IV. Provider business mailing address

630 S 400 E STE 101
ST GEORGE UT
84770-3765
US

V. Phone/Fax

Practice location:
  • Phone: 435-673-9653
  • Fax: 435-673-9008
Mailing address:
  • Phone: 435-673-9653
  • Fax: 435-673-9008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number124012
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: