Graham, Jean
Graham, Jean is an sole proprietor health care provider with primary practice located at 4801 N Butler Ave , Farmington NM 87401-6002. She recently has only one registered license in Other Service Providers / Specialist, which is considered as her primary health care specialty. Graham, Jean can be contacted via phone (505) 324-8375.Contact Information
Primary practice address
4801 N Butler Ave
Farmington NM 87401-6002
Phone: (505) 324-8375
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | 97-254 | New Mexico |
Profile Details
| NPI number | 1508920661 |
|---|---|
| LBN Legal business name | Graham, Jean |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Dec 21st, 2006 |
| Last updated | Jul 8th, 2007 - about 18 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 | 1508920661 | NPPES |
| New Mexico | MEDICAID | Q2833 | |
| New Mexico | Other | 84-1497491-001 | |
| New Mexico | Other | NM012425 |
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