Provider Demographics
NPI:1073711339
Name:ALAN D GRAHAM
Entity Type:Organization
Organization Name:ALAN D GRAHAM
Other - Org Name:ALPHA SURGICAL SPECIALISTS
Other - Org Type:Other Name
Authorized Official - Title/Position:MD GENERAL SURGEON
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-878-6633
Mailing Address - Street 1:PO BOX 1067
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-1067
Mailing Address - Country:US
Mailing Address - Phone:606-878-6633
Mailing Address - Fax:606-878-5883
Practice Address - Street 1:200 CITY HILL DRIVE
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-3038
Practice Address - Country:US
Practice Address - Phone:606-878-6633
Practice Address - Fax:606-878-5883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24150208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64241508Medicaid
020042779OtherRAILROAD MEDICARE GRAHAM
6782Medicare PIN
020042779OtherRAILROAD MEDICARE GRAHAM