Provider Demographics
NPI:1356483861
Name:GRAHAM, DRAYTON P (MD)
Entity Type:Individual
Prefix:DR
First Name:DRAYTON
Middle Name:P
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DRAYTON
Other - Middle Name:P
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DRAYTON P GRAHAMMD
Mailing Address - Street 1:4477 W 118TH ST STE 405
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-2259
Mailing Address - Country:US
Mailing Address - Phone:310-970-1930
Mailing Address - Fax:310-970-1979
Practice Address - Street 1:4477 W 118TH ST STE 405
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2259
Practice Address - Country:US
Practice Address - Phone:310-970-1930
Practice Address - Fax:928-268-0107
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27833207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA953385758OtherDRAYTON P. GRAHAM M.D. MEDICAL INC
CA00G278330Medicaid
CA953385758Medicare PIN
A43513Medicare UPIN
CA00G278330Medicaid