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General NPI Number Information
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NPI Number | 1114847191
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Entity Type | Individual
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Provider Name | PATRICK GRAHAM
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Gender | Male
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Dates
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Enumeration Date | 07/20/2026
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Last Update Date | 07/20/2026
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Provider Practice Location Address
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Address Line | 1314 E LAS OLAS BLVD # 2658
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City | FORT LAUDERDALE
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State | FL
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Zip | 33301-2334
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Country | US
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Telephone | 786-938-9372
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 551606
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City | OPA LOCKA
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State | FL
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Zip | 33055-0606
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Country | US
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Telephone | 786-938-9372
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State | FL
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