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General NPI Number Information
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NPI Number | 1134270390
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Entity Type | Individual
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Provider Name | CHARLES E. GRAHAM M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3435 W CRAIG RD STE A
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89032-5116
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Country | US
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Telephone | 702-733-6673
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 34405 3435 W. CRAIG RD. SUITE A
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City | LAS VEGAS
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State | NV
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Zip | 89133-4405
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Country | US
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Telephone | 702-733-6673
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 6794
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 21459
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 22808
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License Number State | KS
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