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NPI Code Detail

MEDICARE: CHARLES E GRAHAM MD LTD

MEDICARE: CHARLES E GRAHAM MD LTD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207W00000XOphthalmology Physician

General Provider Information

NPI Number : 1124216353
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHARLES E GRAHAM MD LTD
Provider Business Mailing Address
First Line : PO BOX 34405
Second Line : 3435 W CRAIG RD SUITE A
City : LAS VEGAS
State : NV
Zip : 89133-4405
Country : US
Telephone Number : 702-733-6673
Fax Number : 702-633-0077
Provider Business Practice Location Address
First Line : 3435 W CRAIG RD STE A
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89032-5116
Country : US
Telephone Number : 702-733-6673
Fax Number : 702-633-0077
Authorized Official
Title or Position : CEO
Name : DR. CHARLES E. GRAHAM
Credential : M.D.
Telephone Number : 702-733-6673
Provider Enumeration Date : 10/12/2007
Last Update Date : 04/16/2008

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