Provider Demographics
NPI:1336109461
Name:GRAHAM, STUART MALCOLM II (MD)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:MALCOLM
Last Name:GRAHAM
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11211 PROSPERITY FARMS RD
Mailing Address - Street 2:SUITE D129 - OAKPARK
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-3446
Mailing Address - Country:US
Mailing Address - Phone:561-775-9288
Mailing Address - Fax:561-828-5834
Practice Address - Street 1:11211 PROSPERITY FARMS RD
Practice Address - Street 2:SUITE D129 - OAKPARK
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-3446
Practice Address - Country:US
Practice Address - Phone:561-775-9288
Practice Address - Fax:561-624-4460
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME37835207ZC0500X, 207ZF0201X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Not Answered207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology