Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | G9967 | TX |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | G9967 | TX |
NPI | 1023107851 |
---|---|
Provider Name | Phillip Madsen Graehl |
First Address | Carrollton, TX 75010-4615 |
Second Address | Carrollton, TX 75010-4615 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 01/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
122271305 | (05) | TX |
6484850003 | MEDICARE NSC - EFFECT. 02/01/2011 (01) | TX |
8CR155 | BCBS TX 02/01/11 (01) | TX |
8F4981 | BLUE CROSS BLUE SHIELD (01) | TX |
C97799 | (02) | TX |
P00913367 | MEDICARE RAILROAD - EFFECT. 02/01/2011 (01) | TX |
TXB117513 | MEDICARE PART B - EFFECT 02/01/2011 (01) | TX |