Provider Demographics
NPI:1497737621
Name:GRAHAM, DONALD DEAN JR (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:DEAN
Last Name:GRAHAM
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:148 HIGHWAY 105 EXT
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5681
Mailing Address - Country:US
Mailing Address - Phone:336-386-2746
Mailing Address - Fax:336-386-2750
Practice Address - Street 1:148 HIGHWAY 105 EXT
Practice Address - Street 2:SUITE 104
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5681
Practice Address - Country:US
Practice Address - Phone:336-386-2746
Practice Address - Fax:336-386-2750
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9401410207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8936641Medicaid
NC8936641Medicaid
NC2204556CMedicare PIN