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General NPI Number Information
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NPI Number | 1518155258
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Entity Type | Organization
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Legal Business Name | AUDREY L. GRAHAM, MD, PA
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 06/26/2009
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Provider Practice Location Address
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Address Line | 3310 LIVE OAK ST 400
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City | DALLAS
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State | TX
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Zip | 75204-6147
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Country | US
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Telephone | 214-823-6500
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Fax | 214-823-6816
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Provider Business Mailing Address
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Address Line | 3310 LIVE OAK ST 400
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City | DALLAS
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State | TX
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Zip | 75204-6147
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BILLING
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Name | MARGARET KANNADY
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Credential |
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Telephone | 972-613-5379
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | H7060
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License Number State | TX
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