Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | Q2901 | TX |
N | 2080A0000X | Adolescent Medicine | 036108269 | IL |
NPI | 1013903061 |
---|---|
Provider Name | Dr. Barbara Anne Graham |
First Address | Denison, TX 75020-4589 |
Second Address | Denison, TX 75020-4587 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2005 |
Last Update Date | 26/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200584180A | (05) | OK |
346249101 | (05) | TX |