Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 01078449A | IN |
N | 207SG0201X | Clinical Genetics (M.D.) | L6918 | TX |
N | 208000000X | Pediatrician | L6918 | TX |
NPI | 1861572117 |
---|---|
Provider Name | Dr. Brett Harrison Graham |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Indianapolis, IN 46202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 19/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
162909901 | (05) | TX |
H98799 | (02) |