Provider Demographics
NPI:1356339048
Name:GRAHAM, NELSON VERE JR (MD)
Entity type:Individual
Prefix:DR
First Name:NELSON
Middle Name:VERE
Last Name:GRAHAM
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:801 SAINT MARYS DR
Mailing Address - Street 2:SUITE 201 EAST
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0511
Mailing Address - Country:US
Mailing Address - Phone:812-475-8975
Mailing Address - Fax:812-471-8322
Practice Address - Street 1:801 SAINT MARYS DR
Practice Address - Street 2:SUITE 201 EAST
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0511
Practice Address - Country:US
Practice Address - Phone:812-475-8975
Practice Address - Fax:812-471-8322
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2010-03-04
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Provider Licenses
StateLicense IDTaxonomies
IN01025814A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100254120AMedicaid
IN100254120AMedicaid
D70871Medicare UPIN