Provider Demographics
NPI:1780732636
Name:MOUW, GRAHAM J (MD)
Entity type:Individual
Prefix:DR
First Name:GRAHAM
Middle Name:J
Last Name:MOUW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6129 SW 70TH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3451
Mailing Address - Country:US
Mailing Address - Phone:310-770-2489
Mailing Address - Fax:786-871-6801
Practice Address - Street 1:6129 SW 70TH ST
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-3451
Practice Address - Country:US
Practice Address - Phone:786-871-6800
Practice Address - Fax:786-871-6801
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME112831207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14TK4OtherBCBS