Provider Demographics
NPI:1740501196
Name:GARY C GRAHAM, M.D., INC
Entity type:Organization
Organization Name:GARY C GRAHAM, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-383-1111
Mailing Address - Street 1:517 W 23RD ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-3724
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty