Provider Demographics
NPI:1811099153
Name:GRAHAM, ROBERT R (CRNA)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:R
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 CR 250
Mailing Address - Street 2:
Mailing Address - City:WEIMAR
Mailing Address - State:TX
Mailing Address - Zip Code:78962
Mailing Address - Country:US
Mailing Address - Phone:979-263-5200
Mailing Address - Fax:
Practice Address - Street 1:400 YOUENS DR
Practice Address - Street 2:
Practice Address - City:WEIMAR
Practice Address - State:TX
Practice Address - Zip Code:78962
Practice Address - Country:US
Practice Address - Phone:979-725-9531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX027848367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
83102CMedicare UPIN
TX83102CMedicare ID - Type Unspecified