Provider Demographics
NPI:1255621249
Name:GRAHAM, DAVID ESCHOL (PA-C)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ESCHOL
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11684 MARSH ELDER DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32226-2053
Mailing Address - Country:US
Mailing Address - Phone:904-716-8617
Mailing Address - Fax:
Practice Address - Street 1:1205 MONUMENT RD STE 203
Practice Address - Street 2:INDUSTRIAL MEDICINE
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-6482
Practice Address - Country:US
Practice Address - Phone:904-665-7484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101460363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant