Provider Demographics
NPI:1114152014
Name:GRAHAM, JOHN DUNCAN III (IDMT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DUNCAN
Last Name:GRAHAM
Suffix:III
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 80
Mailing Address - Street 2:BOX 17557
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96367
Mailing Address - Country:US
Mailing Address - Phone:318-775-0292
Mailing Address - Fax:
Practice Address - Street 1:18 MEDICAL OPERATIONS SQUADRON
Practice Address - Street 2:UNIT 5269
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96368-5269
Practice Address - Country:US
Practice Address - Phone:318-775-0292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2009-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians