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NPI Code Detail

MEDICARE: DR. JORDAN MACKAY GRAFF MD

MEDICARE: DR. JORDAN MACKAY GRAFF MD
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
1207W00000XOphthalmology Physician41796AZ
2207WX0107XRetina Specialist (Ophthalmology) Physician41796AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
255970OTHERIAWELLMARK BCBS

General Provider Information

NPI Number : 1952487829
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JORDAN MACKAY GRAFF MD
Provider Business Mailing Address
First Line : 4800 N 22ND ST STE 210
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-4963
Country : US
Telephone Number : 602-955-1000
Fax Number : 602-508-4830
Provider Business Practice Location Address
First Line : 4800 N 22ND ST STE 120
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-4962
Country : US
Telephone Number : 602-955-1000
Fax Number : 602-508-4830
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2006
Last Update Date : 01/10/2022

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