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General NPI Number Information
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NPI Number | 1811947344
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Entity Type | Individual
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Provider Name | ADAM W GRAHAM P.A.
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Gender | Male
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 08/19/2010
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Provider Practice Location Address
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Address Line | 12499 CLAIMSTAKE CT
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City | LOLO
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State | MT
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Zip | 59847-9435
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Country | US
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Telephone | 406-493-8269
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Fax |
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Provider Business Mailing Address
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Address Line | 12499 CLAIMSTAKE CT
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City | LOLO
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State | MT
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Zip | 59847-9435
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Country | US
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Telephone | 406-493-8269
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5703835-1206
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 5703835-1206
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MT 503
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License Number State | MT
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