Dr. Stephen J. Graham, M.D.
General Practice in Gold Canyon, AZ. Individual provider (NPI-1).
NPI number1790778520
StatusActive
Last updated in NPPESJul 13, 2021
Details
- NPI
- 1790778520
- Entity type
- Individual (NPI-1)
- Name
- Dr. Stephen J. Graham
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Aug 26, 2005
- Certification date
- Jul 13, 2021
- Last updated
- Jul 13, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208D00000X | General Practice | 184400-1205 | UT | Yes |
| 207W00000X | Ophthalmology | 184400-1205 | UT | |
| 207W00000X | Ophthalmology | 19987 | AZ | |
| 208D00000X | General Practice | 19987 | AZ |
Practice location
9983 E Desert Trail LnGold Canyon, AZ 85118-4922
Phone 406-425-1355 · Fax 801-618-4185
Mailing address
9983 E Desert Trail LnGold Canyon, AZ 85118-4922
Phone 064-251-3554 · Fax 801-618-4185
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