Graham, Tanith M.
Graham, Tanith M. is an individual health care provider with primary practice located at 2869 Sw Champlain Dr , Portland OR 97205-5833. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Anesthesiology, Allopathic & Osteopathic Physicians / Pain Medicine. Allopathic & Osteopathic Physicians / Anesthesiology is his primary health care specialty. Graham, Tanith M. can be contacted via phone (503) 709-8787.Contact Information
Primary practice address
2869 Sw Champlain Dr
Portland OR 97205-5833
Phone: (503) 709-8787
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Anesthesiology | 207L00000X | MD13201 | Oregon |
| Allopathic & Osteopathic Physicians / Pain Medicine | 207LP2900X | MD13201 | Oregon |
| Allopathic & Osteopathic Physicians / Anesthesiology | 207L00000X | 09591 | Mississippi |
Profile Details
| NPI number | 1790752640 |
|---|---|
| LBN Legal business name | Graham, Tanith M. |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 28th, 2006 |
| Last updated | Jan 18th, 2018 - about 6 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 | 1790752640 | NPPES |
| Washington | MEDICAID | 1037381 | |
| Washington | MEDICAID | 7394381-00 | |
| Washington | MEDICAID | 02121230 | |
| Washington | Other | 050032614 | |
| Washington | MEDICAID | 117006 |
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