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General NPI Number Information
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NPI Number | 1427452549
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Entity Type | Organization
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Legal Business Name | LOYCE J. GRAHAM, M. D. PLLC
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Dates
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Enumeration Date | 10/17/2014
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Last Update Date | 10/17/2014
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Provider Practice Location Address
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Address Line | 181 TOWN CENTER BLVD SUITE 400
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City | JARRELL
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State | TX
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Zip | 76537-4001
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Country | US
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Telephone | 254-718-5328
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Fax |
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Provider Business Mailing Address
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Address Line | 18410 DONAHOE LN
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City | BARTLETT
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State | TX
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Zip | 76511-4084
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Country | US
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Telephone | 254-527-3377
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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. LOYCE J. GRAHAM
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Credential | MD
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Telephone | 254-718-5328
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | J1483
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License Number State | TX
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