Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 0101044491 | VA |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 0101044491 | VA |
NPI | 1083625511 |
---|---|
Provider Name | Dr. R. Michael Graham |
First Address | Norfolk, VA 23505-4604 |
Second Address | Norfolk, VA 23505-4604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 13/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010140811 | (05) | VA |
E11839 | (02) | VA |