Provider Demographics
NPI:1508993429
Name:GRAUMAN, DAVID S (MD, PC, MRO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:GRAUMAN
Suffix:
Gender:M
Credentials:MD, PC, MRO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 LATHROP ST STE 203
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-5943
Mailing Address - Country:US
Mailing Address - Phone:907-456-2825
Mailing Address - Fax:907-451-0742
Practice Address - Street 1:1919 LATHROP ST STE 203
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5943
Practice Address - Country:US
Practice Address - Phone:907-456-2825
Practice Address - Fax:907-451-0742
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1058207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD1058Medicaid
AKMD1058Medicaid