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NPI Code Detail

MEDICARE: MR. DONALD BRADLEY GRAHAM MSW,MPA

MEDICARE: MR. DONALD BRADLEY GRAHAM MSW,MPA
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
11041C0700XClinical Social WorkerFL

General Provider Information

NPI Number : 1750573580
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DONALD BRADLEY GRAHAM MSW,MPA
Provider Business Mailing Address
First Line : 6909 E HIGHWAY 22
Second Line :
City : PANAMA CITY
State : FL
Zip : 32404-2370
Country : US
Telephone Number : 850-874-0715
Fax Number : 850-874-0716
Provider Business Practice Location Address
First Line : 6909 E HIGHWAY 22
Second Line :
City : PANAMA CITY
State : FL
Zip : 32404-2370
Country : US
Telephone Number : 850-874-0715
Fax Number : 850-874-0716
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2007
Last Update Date : 08/29/2007

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