Provider Demographics
NPI:1437564267
Name:GRAHAM, JAMIE (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:ARON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1855 5TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-4325
Mailing Address - Country:US
Mailing Address - Phone:714-269-1821
Mailing Address - Fax:
Practice Address - Street 1:601 5TH ST S STE 501
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4804
Practice Address - Country:US
Practice Address - Phone:727-767-3782
Practice Address - Fax:727-767-3782
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14506208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty