=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972042372
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRAHAM HEALTHCARE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2017
-----------------------------------------------------
Last Update Date | 02/17/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1005 STATE HIGHWAY 16 S
-----------------------------------------------------
City | GRAHAM
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76450-3835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-282-2513
-----------------------------------------------------
Fax | 940-521-9139
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1005 STATE HIGHWAY 16 S
-----------------------------------------------------
City | GRAHAM
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76450-3835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-282-2513
-----------------------------------------------------
Fax | 940-521-9139
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING DIRECTOR/MEMBER
-----------------------------------------------------
Name | DR. AARON GARRETT PURDY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 940-282-2513
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | N4004
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------