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NPI Code Detail

MEDICARE: DR. SCOTT MICHAEL GRAHAM M.D.

MEDICARE: DR. SCOTT MICHAEL 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
1207X00000XOrthopaedic Surgery PhysicianA61526CA
2207XX0005XSports Medicine (Orthopaedic Surgery) PhysicianA61526CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3RR2000 42895OTHERCAMEDICARE RAILROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100A615260G89OTHERCACAL-OPTIMA
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1902809551
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SCOTT MICHAEL GRAHAM M.D.
Provider Business Mailing Address
First Line : 24331 EL TORO RD STE 200
Second Line :
City : LAGUNA WOODS
State : CA
Zip : 92637-3116
Country : US
Telephone Number : 949-586-3200
Fax Number : 949-900-2136
Provider Business Practice Location Address
First Line : 24331 EL TORO RD STE 200
Second Line :
City : LAGUNA WOODS
State : CA
Zip : 92637-3116
Country : US
Telephone Number : 949-586-3200
Fax Number : 949-900-2136
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2005
Last Update Date : 10/16/2023

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