Provider Demographics
NPI:1316042450
Name:GRAHAM, RICHARD ALTON (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALTON
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:31331 COAST HWY
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-6989
Mailing Address - Country:US
Mailing Address - Phone:949-584-3417
Mailing Address - Fax:949-415-1130
Practice Address - Street 1:1025 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-1329
Practice Address - Country:US
Practice Address - Phone:213-861-5854
Practice Address - Fax:213-861-5916
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG533542084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA52504Medicare UPIN