Provider Demographics
NPI:1558450254
Name:GRAHAM, WILLIAM NOBLE (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:NOBLE
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 N FOSTER ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-2969
Mailing Address - Country:US
Mailing Address - Phone:605-996-8386
Mailing Address - Fax:605-996-9153
Practice Address - Street 1:625 N FOSTER ST
Practice Address - Street 2:SUITE 203
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-2969
Practice Address - Country:US
Practice Address - Phone:605-996-8386
Practice Address - Fax:605-996-9153
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4248207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD2070OtherAVERA HEALTH
SD0005047OtherBCBS
SD6520252Medicaid
SD20223OtherSIOUX VALLEY
SD0005047OtherBCBS
SDG48495Medicare UPIN
SD2070OtherAVERA HEALTH