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General NPI Number Information
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NPI Number | 1972679322
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Entity Type | Organization
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Legal Business Name | PERINATAL MEDICINE ASSOCIATES, LLP
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 04/22/2008
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Provider Practice Location Address
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Address Line | 1600 W COLLEGE ST SUITE 210
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City | GRAPEVINE
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State | TX
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Zip | 76051-3580
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Country | US
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Telephone | 817-481-0111
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Fax | 817-481-0112
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Provider Business Mailing Address
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Address Line | PO BOX 100186
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City | FORT WORTH
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State | TX
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Zip | 76185-0186
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Country | US
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Telephone | 817-731-7771
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Fax | 817-731-7774
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Authorized Official
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Title or Position | MD
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Name | DR. JACK MONROE GRAHAM
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Credential | MD
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Telephone | 817-481-0111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number |
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License Number State |
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