Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 20985 | CA |
NPI | 1437219318 |
---|---|
Provider Name | Dr. Chester Duncan Graham |
First Address | Modesto, CA 95356-9026 |
Second Address | Modesto, CA 95356-9026 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U31249 | (02) | CA |