Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 52 | TX |
N | 222Z00000X | Podiatrist | 52 | TX |
Y | 224P00000X | Prosthetist | 52 | TX |
NPI | 1497012074 |
---|---|
Provider Name | Deborah V Graham |
First Address | Fort Worth, TX 76199-0283 |
Second Address | Fort Worth, TX 76110-1349 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2012 |
Last Update Date | 19/04/2012 |