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General NPI Number Information
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NPI Number | 1285924837
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Entity Type | Organization
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Legal Business Name | GRAHAM DERMATOLOGY CENTER, P.C.
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Dates
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Enumeration Date | 04/17/2011
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Last Update Date | 08/19/2016
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Provider Practice Location Address
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Address Line | 307 E DANFORTH RD SUITE 154
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City | EDMOND
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State | OK
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Zip | 73034-4483
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Country | US
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Telephone | 405-216-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 307 E DANFORTH RD SUITE 154
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City | EDMOND
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State | OK
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Zip | 73034-4483
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Country | US
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Telephone | 405-216-0100
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID L GRAHAM
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Credential | M.D.
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Telephone | 405-216-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | 20601
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License Number State | OK
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