| Organization Name: | SUSAN B GRAHAM INC |
| NPI Number: | 1023269198 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SUSAN B GRAHAM (PRESIDENT) |
| Mailing Address: | 835 Spruce St Espanola |
| State: | NM US |
| Postal Code: | 875323455 |
| Phone Number: | 5058847059 |
| Fax Number: | |
| NPI Enumeration Date: | 10/07/2008 |
| NPI Last Update Date: | 10/07/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207VG0400X |
| License Number: | 86-237 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Obstetrics & Gynecology |
| Taxonomy Specialization: | Gynecology |
| Taxonomy Definition: | |