MEDICARE: MR. GRAHAM DOUGLAS AVERY MD

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	207W00000X	Ophthalmology Physician	F3725	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285666024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GRAHAM DOUGLAS AVERY MD

Provider Business Mailing Address
First Line	:	740 HOSPITAL DR
Second Line	:	STE 200
City	:	BEAUMONT
State	:	TX
Zip	:	77701-4663
Country	:	US
Telephone Number	:	409-832-8883
Fax Number	:	409-833-5755

Provider Business Practice Location Address
First Line	:	740 HOSPITAL DR
Second Line	:	STE 200
City	:	BEAUMONT
State	:	TX
Zip	:	77701-4663
Country	:	US
Telephone Number	:	409-832-8883
Fax Number	:	409-833-5755

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	06/26/2008

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