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General NPI Number Information
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NPI Number | 1477630689
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Entity Type | Individual
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Provider Name | JOHN MICHAEL GRAM PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 12/09/2019
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Provider Practice Location Address
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Address Line | 1175 E MAIN ST STE 2D
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City | MEDFORD
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State | OR
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Zip | 97504-7457
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Country | US
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Telephone | 541-772-7010
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Fax | 541-205-4251
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Provider Business Mailing Address
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Address Line | 980 SW 6TH ST STE 18
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City | GRANTS PASS
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State | OR
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Zip | 97526-2910
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Country | US
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Telephone | 541-471-7010
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Fax | 541-471-8841
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 975
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License Number State | OR
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