MEDICARE: DR. STEVEN DOUGLAS GRAHAM PH.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	103TC0700X	Clinical Psychologist	PY6884	FL

General Provider Information

NPI Number	:	1619290020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN DOUGLAS GRAHAM PH.D.

Provider Business Mailing Address
First Line	:	300 S HYDE PARK AVE
Second Line	:	SUITE 220
City	:	TAMPA
State	:	FL
Zip	:	33606-2286
Country	:	US
Telephone Number	:	813-732-6717
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 S HYDE PARK AVE
Second Line	:	SUITE 220
City	:	TAMPA
State	:	FL
Zip	:	33606-2286
Country	:	US
Telephone Number	:	813-732-6717
Fax Number	:

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

Provider Enumeration Date	:	03/12/2010
Last Update Date	:	03/12/2010

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