Provider Demographics
NPI:1275549982
Name:GRAHAM, GLENN D (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:D
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
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Mailing Address - Street 1:337 WHITEOAKS DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-1410
Mailing Address - Country:US
Mailing Address - Phone:505-265-1711
Mailing Address - Fax:505-256-5720
Practice Address - Street 1:VAMC
Practice Address - Street 2:1501 SAN PEDRO DRIVE SE
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108
Practice Address - Country:US
Practice Address - Phone:505-265-1711
Practice Address - Fax:505-256-5720
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM95-2482084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology