Provider Demographics
NPI:1437359056
Name:GRAHAM, JOSEPH MARK (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MARK
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:14785 OLD SAINT AUGUSTINE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-7407
Mailing Address - Country:US
Mailing Address - Phone:904-456-0017
Mailing Address - Fax:904-456-0018
Practice Address - Street 1:14785 OLD SAINT AUGUSTINE RD STE 100
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-7407
Practice Address - Country:US
Practice Address - Phone:904-578-5943
Practice Address - Fax:904-456-0018
Is Sole Proprietor?:No
Enumeration Date:2007-07-22
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013009584207X00000X, 207X00000X
FLOS11534207XS0117X, 207X00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1437359056OtherFIRST HEALTH NETWORK
FL1437359056OtherCIGNA
FL1437359056OtherASCENSION HEALTH
FL759044500OtherCSNI - DEPT OF LABOR
FLPENDINGOtherAETNA
FL1437359056OtherHUMANA
FL004857900Medicaid
FL1437359056OtherHUMANA MILITARY
FL759044900OtherCSNI - DEPT OF LABOR
FL1437359056OtherPRIME HEALTH SERVICES, INC.
FL14KA4EOtherBCBS
FL1437359056OtherPARADIGM