Provider Demographics
NPI:1861476020
Name:GRAHAM, BARBARA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:ANN
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10912 NW LUSANNE CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-6172
Mailing Address - Country:US
Mailing Address - Phone:503-671-9333
Mailing Address - Fax:503-626-8366
Practice Address - Street 1:12672 NW BARNES RD
Practice Address - Street 2:SUITE #100
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-6016
Practice Address - Country:US
Practice Address - Phone:503-644-7434
Practice Address - Fax:503-350-1754
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD 15611207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR017181Medicaid
ORK1059-01OtherPACIFICSOURCE
OR0000BKBPLMedicare ID - Type Unspecified
OR017181Medicaid