Provider Demographics
NPI:1184827461
Name:GRAHAM, JEFF DAVID
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:DAVID
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 W HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3545
Mailing Address - Country:US
Mailing Address - Phone:707-444-8213
Mailing Address - Fax:
Practice Address - Street 1:1010 W HENDERSON ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3545
Practice Address - Country:US
Practice Address - Phone:707-444-8213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management