Graham, Jack M

Graham, Jack M is an individual health care provider with primary practice located at 1500 S Main St , Fort Worth TX 76104-4917. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, Allopathic & Osteopathic Physicians / Maternal & Fetal Medicine. Allopathic & Osteopathic Physicians / Maternal & Fetal Medicine is his primary health care specialty. Graham, Jack M can be contacted via phone (817) 702-1166.

Contact Information

Primary practice address
1500 S Main St Fort Worth TX 76104-4917
Phone: (817) 702-1166
Fax: (817) 702-1405
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X F1600 Texas
Allopathic & Osteopathic Physicians / Maternal & Fetal Medicine 207VM0101X F1600 Texas

Profile Details

NPI number 1205801347
LBN Legal business name Graham, Jack M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 22nd, 2006
Last updated Dec 28th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1205801347 NPPES
Texas Other 8H3360 BCBS
Texas MEDICAID 139366218 BCBS
Texas MEDICAID 139366223 BCBS
Texas Other 4227216 BCBS
Texas MEDICAID 139366219 BCBS
Texas Other 10028874 BCBS

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