Provider Demographics
NPI:1700801313
Name:GRAHAM, SCOTT ALLAN (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALLAN
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HARRIS CT BLDG A
Mailing Address - Street 2:STE A1
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5704
Mailing Address - Country:US
Mailing Address - Phone:831-643-9788
Mailing Address - Fax:831-657-0161
Practice Address - Street 1:10 HARRIS CT BLDG A
Practice Address - Street 2:STE A1
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5704
Practice Address - Country:US
Practice Address - Phone:831-643-9788
Practice Address - Fax:831-657-0161
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23186207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ49708OtherEMPIRE BC
AZP00340986OtherMEDICARE RAILROAD
AZ187479Medicaid
AZ4445600OtherCIGNA
AZAZ0442680OtherAZ BLUE CROSS/BLUE SHIELD
AZP00340986OtherMEDICARE RAILROAD