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General NPI Number Information
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NPI Number | 1528084464
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Entity Type | Individual
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Provider Name | IAN R GRAHAM M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 10/29/2020
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Provider Practice Location Address
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Address Line | HENRY COUNTY MEDICAL CENTER 301 TYSON AVENUE
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City | PARIS
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State | TN
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Zip | 38424
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Country | US
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Telephone | 731-644-8535
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Fax | 731-642-9588
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Provider Business Mailing Address
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Address Line | PO BOX 2153 DEPT 30755
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City | BIRMINGHAM
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State | AL
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Zip | 35287-9283
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Country | US
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Telephone | 314-238-5260
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Fax | 314-821-1833
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 036107429
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 2002015742
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License Number State | MO
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