Provider Demographics
NPI:1548212954
Name:GRAHAM, FREDERICK S (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:S
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4280 WATERMELON RD STE 111
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-5250
Mailing Address - Country:US
Mailing Address - Phone:205-333-8554
Mailing Address - Fax:205-752-7696
Practice Address - Street 1:4280 WATERMELON RD STE 111
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-5250
Practice Address - Country:US
Practice Address - Phone:205-333-8554
Practice Address - Fax:205-752-7696
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22790208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-97145OtherBC BS OF AL
AL51510659OtherBLUE CROSS BLUE SHIELD
AL1548212954Medicaid
AL107836Medicaid
AL051510659Medicaid
AL51517554OtherBLUE CROSS BLUE SHIELD
AL51109440OtherBLUE CROSS BLUE SHIELD OF AL
AL515-95961OtherBC BS OF AL
AL515-97150OtherBC BS OF AL
AL510I250022Medicare PIN
AL515-97145OtherBC BS OF AL
AL1548212954Medicare UPIN
AL051510659Medicaid