Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 82132 | AZ |
NPI | 1003089319 |
---|---|
Provider Name | Holly Jeanne Graham |
First Address | Bend, OR 97701-6973 |
Second Address | Tucson, AZ 85712 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2008 |
Last Update Date | 03/06/2011 |