Provider Demographics
NPI:1922535830
Name:JEMAAR GRAHAM DPM PA
Entity Type:Organization
Organization Name:JEMAAR GRAHAM DPM PA
Other - Org Name:EXCEL FOOT AND ANKLE SPECIALIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICIER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEMAAR
Authorized Official - Middle Name:LEKEI
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:863-398-6309
Mailing Address - Street 1:12839 GRAND BANK LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-2737
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12839 GRAND BANK LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-2737
Practice Address - Country:US
Practice Address - Phone:863-398-6309
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-23
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3096261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric