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General NPI Number Information
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NPI Number | 1063647154
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Entity Type | Organization
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Legal Business Name | GRAHAM EAR, NOSE & THROAT P.C.
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Dates
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Enumeration Date | 05/19/2009
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Last Update Date | 05/19/2009
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Provider Practice Location Address
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Address Line | 625 N FOSTER ST STE 203
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City | MITCHELL
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State | SD
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Zip | 57301-2969
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Country | US
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Telephone | 605-996-8386
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Fax | 605-996-9153
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Provider Business Mailing Address
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Address Line | 625 N FOSTER ST STE 203
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City | MITCHELL
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State | SD
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Zip | 57301-2969
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Country | US
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Telephone | 605-996-8386
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Fax | 605-996-9153
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Authorized Official
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Title or Position | OWNER
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Name | WILLIAM NOBLE GRAHAM
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Credential | D.O.
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Telephone | 605-996-8386
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number | 4248
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License Number State | SD
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