MEDICARE: DR. DAVID BUOY GRAHAM 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	207Q00000X	Family Medicine Physician	43056	CO

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	:	1386759264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID BUOY GRAHAM MD

Provider Business Mailing Address
First Line	:	PO BOX 19670
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62794-9670
Country	:	US
Telephone Number	:	217-757-8100
Fax Number	:	217-747-1351

Provider Business Practice Location Address
First Line	:	520 NORTH 4TH STREET
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62794-9670
Country	:	US
Telephone Number	:	217-757-8100
Fax Number	:	217-747-1351

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	10/23/2020

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