Doctor Name: | ROBERT WALLACE GRAHAM |
NPI Number: | 1629393160 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.O. |
License Number: | |
Business Practice Address: | 800 Mercy Dr Council Bluffs, IA - 515033128 |
Business Phone Number: | 8008750136 |
Business Fax Number: | 9376194150 |
Mailing Address: | 4750 Hempstead Station Dr, KETTERING |
State: | OH |
Postal Code: | 454295164 |
Phone Number: | 8008750136 |
Fax Number: | 9376194150 |
NPI Enumeration Date: | 03/27/2010 |
NPI Last Update Date: | 06/03/2013 |
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. |