Provider Demographics
NPI:1669663290
Name:HILL, GRAHAM L (DO)
Entity Type:Individual
Prefix:
First Name:GRAHAM
Middle Name:L
Last Name:HILL
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 1:2219 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-2483
Mailing Address - Country:US
Mailing Address - Phone:775-777-9669
Mailing Address - Fax:
Practice Address - Street 1:2219 N 5TH ST
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-2483
Practice Address - Country:US
Practice Address - Phone:775-777-9669
Practice Address - Fax:775-778-9559
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245835-1208D00000X, 2081P2900X
NVDO2831208100000X
UT5767466-1204208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000064441Medicare PIN