Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 018221 | LA |
NPI | 1083776868 |
---|---|
Provider Name | Dr. Michael E Graham |
First Address | Metairie, LA 70001 |
Second Address | Metairie, LA 70001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1900401 | (05) | LA |
E45530 | (02) | LA |