MEDICARE: DR. JEMAAR GRAHAM DPM

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
1	213ES0103X	Foot & Ankle Surgery Podiatrist	PO3906	FL

General Provider Information

NPI Number	:	1255747705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEMAAR GRAHAM DPM

Provider Business Mailing Address
First Line	:	11065 GATEWOOD DR # C102
Second Line	:
City	:	LAKEWOOD RANCH
State	:	FL
Zip	:	34211-4944
Country	:	US
Telephone Number	:	941-782-8639
Fax Number	:

Provider Business Practice Location Address
First Line	:	11065 GATEWOOD DR # C102
Second Line	:
City	:	LAKEWOOD RANCH
State	:	FL
Zip	:	34211-4944
Country	:	US
Telephone Number	:	941-782-8639
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2014
Last Update Date	:	03/02/2026

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