Provider Demographics
NPI:1326092073
Name:GRAHAM, DOUGLAS E (PA)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:E
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 ALA MOANA BLVD
Mailing Address - Street 2:APARTMENT 709
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-1632
Mailing Address - Country:US
Mailing Address - Phone:808-955-5553
Mailing Address - Fax:808-955-5575
Practice Address - Street 1:1778 ALA MOANA BLVD
Practice Address - Street 2:UL-5
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-1605
Practice Address - Country:US
Practice Address - Phone:808-955-5553
Practice Address - Fax:808-955-5575
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAMD-181363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000242867OtherBC/BS OF HAWAII
HI05715502Medicaid
HI0000242867OtherBC/BS OF HAWAII
HI05715502Medicaid