Provider Demographics
NPI:1033474085
Name:GRAHAM FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:GRAHAM FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TREVA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-928-2208
Mailing Address - Street 1:1002 NE HIGHWAY 66
Mailing Address - Street 2:STE 2
Mailing Address - City:SAYRE
Mailing Address - State:OK
Mailing Address - Zip Code:73662-9305
Mailing Address - Country:US
Mailing Address - Phone:580-928-2208
Mailing Address - Fax:580-928-2246
Practice Address - Street 1:1002 NE HIGHWAY 66
Practice Address - Street 2:STE 2
Practice Address - City:SAYRE
Practice Address - State:OK
Practice Address - Zip Code:73662-9305
Practice Address - Country:US
Practice Address - Phone:580-928-2208
Practice Address - Fax:580-928-2246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty