Provider Demographics
NPI:1851512677
Name:STEPHEN P. GRAHAM, M.D., INC.
Entity Type:Organization
Organization Name:STEPHEN P. GRAHAM, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-597-9002
Mailing Address - Street 1:PO BOX 1326
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92822
Mailing Address - Country:US
Mailing Address - Phone:562-597-9002
Mailing Address - Fax:562-597-9003
Practice Address - Street 1:1760 TERMINO AVE.
Practice Address - Street 2:SUITE G-21
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804
Practice Address - Country:US
Practice Address - Phone:562-597-9002
Practice Address - Fax:562-597-9003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43382207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G433821OtherBLUE SHIELD
CAG43382AMedicare ID - Type Unspecified
00G433821OtherBLUE SHIELD