Provider Demographics
NPI:1437269081
Name:GRAHAM, JOHN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 953010
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-3010
Mailing Address - Country:US
Mailing Address - Phone:314-872-5601
Mailing Address - Fax:314-872-5628
Practice Address - Street 1:2821 N BALLAS RD
Practice Address - Street 2:STE C-11
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2321
Practice Address - Country:US
Practice Address - Phone:314-872-5601
Practice Address - Fax:314-872-5628
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO109904207LP2900X
IL036092540207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO114762OtherBCBS
30087OtherGHP
2000288OtherUNITED HEALTHCARE
050065227OtherRR MEDICARE
115491OtherMERCY
28931OtherCMR
28931OtherGHP ASO LHI
322628OtherHEALTHLINK
0004669135OtherAETNA
MO000094147Medicare ID - Type Unspecified
115491OtherMERCY
322628OtherHEALTHLINK