Provider Demographics
NPI:1689831950
Name:GRAFF, JEREMIAH ANDREW (DPM)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:ANDREW
Last Name:GRAFF
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2633 DALLAS PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4703
Mailing Address - Country:US
Mailing Address - Phone:972-403-7733
Mailing Address - Fax:972-403-7744
Practice Address - Street 1:2633 DALLAS PKWY
Practice Address - Street 2:STE 100
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4703
Practice Address - Country:US
Practice Address - Phone:972-403-7733
Practice Address - Fax:972-403-7744
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1864213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F9469Medicare PIN