Provider Demographics
NPI:1932188265
Name:DRISCOLL, W.GRAHAM (MD)
Entity Type:Individual
Prefix:
First Name:W.GRAHAM
Middle Name:
Last Name:DRISCOLL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WILBUR
Other - Middle Name:GRAHAM
Other - Last Name:DRISCOLL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2320 S 22ND DR
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8867
Mailing Address - Country:US
Mailing Address - Phone:928-783-4476
Mailing Address - Fax:928-782-6722
Practice Address - Street 1:2320 S 22ND DR
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8867
Practice Address - Country:US
Practice Address - Phone:928-783-4476
Practice Address - Fax:928-782-6722
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14982207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ171075Medicaid
AZ171075Medicaid
AZWCKHL20Medicare ID - Type Unspecified