=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841304680
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J.E. GRAHAM PROFESSIONAL ASSOCIATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2006
-----------------------------------------------------
Last Update Date | 04/24/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 212 S BLISS AVE
-----------------------------------------------------
City | DUMAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79029-3806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-934-4975
-----------------------------------------------------
Fax | 806-934-4984
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 212 S BLISS AVE
-----------------------------------------------------
City | DUMAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79029-3806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-934-4975
-----------------------------------------------------
Fax | 806-934-4984
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR/OWNER
-----------------------------------------------------
Name | DR. JUDITH GRAHAM
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 806-934-4975
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VX0000X
-----------------------------------------------------
Taxonomy Name | Obstetrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------