Provider Demographics
NPI:1710182035
Name:GRAHAM, RICHARD J (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
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 1:9601 LILE DR
Mailing Address - Street 2:S-940
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6321
Mailing Address - Country:US
Mailing Address - Phone:501-219-9198
Mailing Address - Fax:501-219-9209
Practice Address - Street 1:9601 LILE DR
Practice Address - Street 2:S-940
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6321
Practice Address - Country:US
Practice Address - Phone:501-219-9198
Practice Address - Fax:501-219-9209
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-08-31
Deactivation Date:2007-08-10
Deactivation Code:
Reactivation Date:2007-08-31
Provider Licenses
StateLicense IDTaxonomies
ARE0016208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation