Provider Demographics
NPI:1568404135
Name:GRAHAM, CONNIE B (MD)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:B
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3517 NW SAMARITAN DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3767
Mailing Address - Country:US
Mailing Address - Phone:541-768-5142
Mailing Address - Fax:541-768-5355
Practice Address - Street 1:3517 NW SAMARITAN DR
Practice Address - Street 2:SUITE 201
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3767
Practice Address - Country:US
Practice Address - Phone:541-768-5142
Practice Address - Fax:541-768-5355
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-11
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORMD19832207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORG41759Medicare UPIN