Provider Demographics
NPI:1356137152
Name:WESTPHAL, GRAHAM SCOTT
Entity type:Individual
Prefix:
First Name:GRAHAM
Middle Name:SCOTT
Last Name:WESTPHAL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 E 3RD ST APT 312
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55812-1746
Mailing Address - Country:US
Mailing Address - Phone:218-341-2091
Mailing Address - Fax:
Practice Address - Street 1:150 CRITTENDEN BLVD BOX 777-R
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642
Practice Address - Country:US
Practice Address - Phone:585-275-4174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program