Provider Demographics
NPI:1306836366
Name:GRAHAM, JOHN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 DRAKES LANDING RD # A
Mailing Address - Street 2:SUITE 225
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2404
Mailing Address - Country:US
Mailing Address - Phone:415-924-1214
Mailing Address - Fax:415-924-1375
Practice Address - Street 1:100 DRAKES LANDING RD # A
Practice Address - Street 2:SUITE 225
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2404
Practice Address - Country:US
Practice Address - Phone:415-924-1214
Practice Address - Fax:415-924-1375
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2010-08-17
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Provider Licenses
StateLicense IDTaxonomies
CAA723880207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH52063Medicare UPIN