Provider Demographics
NPI:1720406580
Name:GRAHAM, PAUL M (DO, FAAD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:M
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:DO, FAAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 CLYDE MORRIS BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8186
Mailing Address - Country:US
Mailing Address - Phone:386-615-1771
Mailing Address - Fax:386-615-1545
Practice Address - Street 1:305 CLYDE MORRIS BLVD STE 150
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8186
Practice Address - Country:US
Practice Address - Phone:386-615-1771
Practice Address - Fax:386-615-1545
Is Sole Proprietor?:No
Enumeration Date:2014-03-30
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS15142207ND0101X, 207NP0225X, 207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107214900Medicaid