MEDICARE: DEBRA A. GRAHAM M.D.

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	MD20364	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G30815	OTHER		UPIN

General Provider Information

NPI Number	:	1548261381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA A. GRAHAM M.D.

Provider Business Mailing Address
First Line	:	3585 BROADWAY AVE
Second Line	:
City	:	NORTH BEND
State	:	OR
Zip	:	97459-1251
Country	:	US
Telephone Number	:	541-756-2584
Fax Number	:	541-756-5783

Provider Business Practice Location Address
First Line	:	3585 BROADWAY ST
Second Line	:
City	:	NORTH BEND
State	:	OR
Zip	:	97459-1251
Country	:	US
Telephone Number	:	541-756-2584
Fax Number	:	541-756-5783

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	03/07/2023

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