Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | E-1260 | AR |
NPI | 1003896580 |
---|---|
Provider Name | Dr. Donna Melissa Graham |
First Address | Little Rock, AR 72205-5302 |
Second Address | Little Rock, AR 72205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2006 |
Last Update Date | 29/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
131802001 | (05) | AR |
A010 | CHAMPUS (01) | AR |
G52878 | (02) | AR |