Doctor Name: | MATTHEW DUANE GRAHAM |
NPI Number: | 1275601320 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.O. |
License Number: | |
Business Practice Address: | 559 Vincent St Peterson Afb, CO - 809141541 |
Business Phone Number: | 7195562273 |
Business Fax Number: | 8668677926 |
Mailing Address: | 559 Vincent St, PETERSON AFB |
State: | CO |
Postal Code: | 809141541 |
Phone Number: | 7195562273 |
Fax Number: | 8668677926 |
NPI Enumeration Date: | 11/30/2006 |
NPI Last Update Date: | 08/10/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |