Provider Demographics
NPI:1619972221
Name:GRAHAM, DENNIS (DO)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:
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 1:150 RIVER NORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-1803
Mailing Address - Country:US
Mailing Address - Phone:254-968-6051
Mailing Address - Fax:254-968-4204
Practice Address - Street 1:150 RIVER NORTH BLVD
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-1803
Practice Address - Country:US
Practice Address - Phone:254-968-6051
Practice Address - Fax:254-968-4204
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2009-09-04
Deactivation Date:2005-09-27
Deactivation Code:
Reactivation Date:2009-03-17
Provider Licenses
StateLicense IDTaxonomies
TXF6684207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141204101MedicaidTEXAS PROVIDER IDENTIFIER
TX8978M0OtherBCBS PROVIDER NUMBER
TN113891100OtherFIRST CARE PROVIDER NUMBE
TX200040612OtherRAILROAD MEDICARE
TX206304301OtherUNITED HEALTHCARE PROV NO
TX6300665002OtherCIGNA PROVIDER NUMBER
TX7182209OtherAETNA PROVIDER NUMBER
TX7182209OtherAETNA PROVIDER NUMBER
TX8678M0Medicare ID - Type UnspecifiedMEDICARE PROVIDER NO
TX141204101MedicaidTEXAS PROVIDER IDENTIFIER