Provider Demographics
NPI:1083889281
Name:GRAHAM, JENNIFER MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MICHELLE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 LA CALMA DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-3843
Mailing Address - Country:US
Mailing Address - Phone:512-452-8533
Mailing Address - Fax:
Practice Address - Street 1:6300 LA CALMA DR
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-3843
Practice Address - Country:US
Practice Address - Phone:512-452-8533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036119370207P00000X
NY248651207P00000X
TXP0874207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine