Provider Demographics
NPI:1639397383
Name:GRAHAM, ERIC DUFFEY (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:DUFFEY
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 N. SPRING STREET
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-2952
Mailing Address - Country:US
Mailing Address - Phone:870-741-6418
Mailing Address - Fax:870-741-5071
Practice Address - Street 1:604 N. SPRING STREET
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2952
Practice Address - Country:US
Practice Address - Phone:870-741-6418
Practice Address - Fax:870-741-5071
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6879208600000X
ARE-7458208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR192759001Medicaid
AR192759001Medicaid