Provider Demographics
NPI:1578558920
Name:GRAHAM, CECIL C (MD)
Entity Type:Individual
Prefix:DR
First Name:CECIL
Middle Name:C
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 1:1301 E MCDOWELL ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2605
Mailing Address - Country:US
Mailing Address - Phone:602-265-8800
Mailing Address - Fax:602-265-8151
Practice Address - Street 1:1301 E MCDOWELL ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2605
Practice Address - Country:US
Practice Address - Phone:602-265-8800
Practice Address - Fax:602-265-8151
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30345207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ834087Medicaid
WV0058548000Medicaid
AZ834087Medicaid
WVE56106Medicare UPIN
WV064405Medicare ID - Type Unspecified