Provider Demographics
NPI:1114423811
Name:DAVIS, GRAHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:GRAHAM
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3985 CUMMINGS RD SUITE 4
Mailing Address - Street 2:NAVAL STATION BOX 368201
Mailing Address - City:APO
Mailing Address - State:AA
Mailing Address - Zip Code:92136
Mailing Address - Country:US
Mailing Address - Phone:619-556-0476
Mailing Address - Fax:
Practice Address - Street 1:34800 BOB WILSON DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-3475
Practice Address - Country:US
Practice Address - Phone:610-246-8040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA187421208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery