Provider Demographics
NPI:1205016052
Name:GRAHAM, WILLIAM B (LAC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:B
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4991 BILFORD LN
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-5747
Mailing Address - Country:US
Mailing Address - Phone:503-442-7893
Mailing Address - Fax:
Practice Address - Street 1:4991 BILFORD LN
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-5747
Practice Address - Country:US
Practice Address - Phone:503-442-7893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01110171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist