Provider Demographics
NPI:1811919194
Name:GRAHAM, DOUGLAS T (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:T
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 1:2811 DEL CURTO RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-4981
Mailing Address - Country:US
Mailing Address - Phone:330-518-8899
Mailing Address - Fax:
Practice Address - Street 1:2811 DEL CURTO RD UNIT B
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-4981
Practice Address - Country:US
Practice Address - Phone:330-518-8899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-084765207L00000X
TXM7227207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH743964OtherBUCKEYE MEDICAID
OH000000225207OtherUNISON
OH2502429Medicaid
OH363579OtherWELLCARE MEDICAID
OH7825578OtherAETNA
OHP00412474OtherMEDICARE RAILROAD
OHP00212694OtherRAILROAD MEDICARE
OH0583328OtherBCMH
I14149Medicare UPIN
OHGR4140484Medicare PIN
OH363579OtherWELLCARE MEDICAID