Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213ES0103X | Foot & Ankle Surgery | 56793490501 | UT |
N | 213ES0103X | Foot & Ankle Surgery | DPM0000000668 | TN |
N | 213ES0103X | Foot & Ankle Surgery | E4772 | CA |
Y | 213ES0103X | Foot & Ankle Surgery | PO60013996 | WA |
NPI | 1003996901 |
---|---|
Provider Name | Jonathan C. Graham |
First Address | Yakima, WA 98902-1263 |
Second Address | Yakima, WA 98908-4319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 11/02/2022 |