Graham, Jackie Lynn
Graham, Jackie Lynn is an individual health care provider with primary practice located at 1600 Se Main St Ste E , Roswell NM 88203-5423. He recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as his primary health care specialty. Graham, Jackie Lynn can be contacted via phone (505) 623-8100.Contact Information
Primary practice address
1600 Se Main St Ste E
Roswell NM 88203-5423
Phone: (505) 623-8100
Fax: (505) 623-8101
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Dermatology | 207N00000X | 74-39 | New Mexico |
Profile Details
| NPI number | 1497851166 |
|---|---|
| LBN Legal business name | Graham, Jackie Lynn |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 16th, 2006 |
| Last updated | Jul 8th, 2008 - about 17 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1497851166 | NPPES |
| New Mexico | MEDICAID | 11023 |
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