Healthcare Provider Details

I. General information

NPI: 1083897771
Provider Name (Legal Business Name): WILLIAM T GRAFF MD FAAFP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 06/10/2008
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:
Mailing address:
  • Phone: 435-673-9653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number162245-1205
License Number StateUT

VIII. Authorized Official

Name: DR. WILLIAM T GRAFF
Title or Position: OWNER
Credential: M.D.
Phone: 435-673-9653