Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 36346 | KY |
N | 207VG0400X | Gynecologist | 36345 | KY |
N | 208800000X | Urologist | 36345 | KY |
NPI | 1669476370 |
---|---|
Provider Name | Carol Ann Graham |
First Address | Chesterfield, MO 63017-3662 |
Second Address | Chesterfield, MO 63017-3662 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 09/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000667083 | ANTHEM (01) | KY |
000000798069 | ANTHEM - WOMEN'S SPECIALISTS (01) | KY |
142082 | SIHO - WS (01) | KY |
200308410 | (05) | IN |
50044196 | PASSPORT - WS (01) | KY |
64031370 | (05) | KY |
F68959 | (02) | KY |