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NPI Code Detail

MEDICARE: DR. SCOTT FITZGERALD GRAHAM M.D.

MEDICARE: DR. SCOTT FITZGERALD 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
1207Q00000XFamily Medicine Physician4301106753MI

General Provider Information

NPI Number : 1861452104
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SCOTT FITZGERALD GRAHAM M.D.
Provider Business Mailing Address
First Line : 6775 CROSSWINDS DR N
Second Line :
City : SAINT PETERSBURG
State : FL
Zip : 33710-5471
Country : US
Telephone Number : 727-381-8006
Fax Number : 727-381-9629
Provider Business Practice Location Address
First Line : 1175 WILSON AVE NW
Second Line :
City : WALKER
State : MI
Zip : 49534-6407
Country : US
Telephone Number : 616-685-8650
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2006
Last Update Date : 05/14/2021

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