Provider Demographics
NPI:1851541783
Name:WALTER E GRAHAM MDPA
Entity Type:Organization
Organization Name:WALTER E GRAHAM MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-359-5330
Mailing Address - Street 1:1331 NORTHPARK DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-1636
Mailing Address - Country:US
Mailing Address - Phone:281-359-5330
Mailing Address - Fax:281-359-6117
Practice Address - Street 1:1331 NORTHPARK DR
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-1636
Practice Address - Country:US
Practice Address - Phone:281-359-5330
Practice Address - Fax:281-359-6117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4357261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPH0533OtherMEDICARE FLU