MEDICARE: ANGUS WOODWARD GRAHAM III 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	207XP3100X	Pediatric Orthopaedic Surgery Physician	9300132	NC
2	207XS0106X	Orthopaedic Hand Surgery Physician	9300132	NC
3	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	9300132	NC
4	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician	9300132	NC
5	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	9300132	NC
6	207XX0801X	Orthopaedic Trauma Physician	9300132	NC
7	207X00000X	Orthopaedic Surgery Physician	9300132	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2034670B	OTHER	NC	MEDICARE PTAN

General Provider Information

NPI Number	:	1417950825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGUS WOODWARD GRAHAM III MD

Provider Business Mailing Address
First Line	:	44 ELKS CLUB RD
Second Line	:
City	:	BREVARD
State	:	NC
Zip	:	28712-3514
Country	:	US
Telephone Number	:	828-553-3397
Fax Number	:

Provider Business Practice Location Address
First Line	:	44 ELKS CLUB RD
Second Line	:
City	:	BREVARD
State	:	NC
Zip	:	28712-3514
Country	:	US
Telephone Number	:	828-553-3397
Fax Number	:

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	02/25/2025

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