Individual provider · NPI-1

Dr. Jon Wessley Graham, MD

Otolaryngology · Fargo, ND

NPI number1992752968
StatusActive
Last updated in NPPESJul 11, 2012

Details

NPI
1992752968
Entity type
Individual (NPI-1)
Name
Dr. Jon Wessley Graham
Credential
MD
Sex
Male
Sole proprietor
No
Enumeration date
May 27, 2006
Last updated
Jul 11, 2012

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Y00000X Otolaryngology12272NDYes
207Y00000X OtolaryngologyME39776FL

Practice location

1702 University Dr S
Fargo, ND 58103-4940

Phone 701-364-3000 · Fax 701-364-8906

Mailing address

Po Box 6001
Fargo, ND 58108-6001

Phone 701-364-3300 · Fax 701-364-8906

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