Provider Demographics
NPI:1003996901
Name:GRAHAM, JONATHAN C (DPM)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:C
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1800 RIVER RD
Mailing Address - Street 2:APARTMENT 152
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-1263
Mailing Address - Country:US
Mailing Address - Phone:801-918-6581
Mailing Address - Fax:801-918-6581
Practice Address - Street 1:502 N 40TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-4319
Practice Address - Country:US
Practice Address - Phone:509-965-0625
Practice Address - Fax:509-966-4967
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM0000000668213ES0103X
UT56793490501213ES0103X
WAPO60013996213ES0103X
CAE4772213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery