Provider Demographics
NPI:1710970264
Name:GRAHAM, GARY C (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:C
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:PO BOX 2038
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95344-0038
Mailing Address - Country:US
Mailing Address - Phone:209-383-1111
Mailing Address - Fax:209-383-0104
Practice Address - Street 1:517 W 23RD ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-3724
Practice Address - Country:US
Practice Address - Phone:209-383-1111
Practice Address - Fax:209-383-0104
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG13700207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G137000Medicaid
CA00G137000Medicaid
CA0190510001Medicare NSC
CA00G137000Medicare PIN