Provider Demographics
NPI:1356508287
Name:GRAHAM, GARY PETER (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:PETER
Last Name:GRAHAM
Suffix:
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 1:1305 W JEFFERSON ST STE 120
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-2251
Mailing Address - Country:US
Mailing Address - Phone:972-923-1457
Mailing Address - Fax:
Practice Address - Street 1:1305 W JEFFERSON ST STE 120
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-2251
Practice Address - Country:US
Practice Address - Phone:972-923-1457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP5810208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3275828-01Medicaid
TX3275828-02Medicaid
TX3275828-01Medicaid
TX318098YNJCMedicare PIN