MEDICARE: MENDOCINO MEDICAL ASSOCIATES, INC

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	G35252	CA
2	207R00000X	Internal Medicine Physician

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598718165
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENDOCINO MEDICAL ASSOCIATES, INC

Provider Business Mailing Address
First Line	:	721 RIVER DR
Second Line	:	SUITE A
City	:	FORT BRAGG
State	:	CA
Zip	:	95437-5402
Country	:	US
Telephone Number	:	707-964-7241
Fax Number	:	707-961-1192

Provider Business Practice Location Address
First Line	:	721 RIVER DR
Second Line	:	SUITE A
City	:	FORT BRAGG
State	:	CA
Zip	:	95437-5402
Country	:	US
Telephone Number	:	707-964-7241
Fax Number	:	707-961-1192

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BENJAMIN GRAHAM
Credential	:	MD
Telephone Number	:	707-964-7241

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	09/11/2025

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