Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2082S0105X | Plastic Hand Surgeon | 49650 | KY |
NPI | 1053866087 |
---|---|
Provider Name | Donald Alexander Graham |
First Address | Louisville, KY 40202-1882 |
Second Address | Louisville, KY 40202-1882 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2016 |
Last Update Date | 24/08/2017 |