Provider Demographics
NPI:1447565106
Name:GRAHAM, CLARA (PA)
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7924 N MACARTHUR BLVD
Mailing Address - Street 2:# 3081
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3736
Mailing Address - Country:US
Mailing Address - Phone:240-388-3865
Mailing Address - Fax:
Practice Address - Street 1:7924 N MACARTHUR BLVD
Practice Address - Street 2:# 3081
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3736
Practice Address - Country:US
Practice Address - Phone:240-388-3865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06810363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical