Provider Demographics
NPI:1285666024
Name:AVERY, GRAHAM DOUGLAS (MD)
Entity Type:Individual
Prefix:MR
First Name:GRAHAM
Middle Name:DOUGLAS
Last Name:AVERY
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Gender:M
Credentials:MD
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Mailing Address - Street 1:740 HOSPITAL DR
Mailing Address - Street 2:STE 200
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4663
Mailing Address - Country:US
Mailing Address - Phone:409-832-8883
Mailing Address - Fax:409-833-5755
Practice Address - Street 1:740 HOSPITAL DR
Practice Address - Street 2:STE 200
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4663
Practice Address - Country:US
Practice Address - Phone:409-832-8883
Practice Address - Fax:409-833-5755
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2008-06-26
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Provider Licenses
StateLicense IDTaxonomies
TXF3725207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114734004Medicaid
TX8C6655Medicare PIN
TX114734004Medicaid