Basic Information
| Provider Information | |||||||||
| NPI: | 1164691366 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRAHAM | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | DAWN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7600 N LA CHOLLA BLVD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857414201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207513675 | ||||||||
| FaxNumber: | 5205475767 | ||||||||
| Practice Location | |||||||||
| Address1: | 7600 N LA CHOLLA BLVD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857414201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207513675 | ||||||||
| FaxNumber: | 5205475767 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2008 | ||||||||
| LastUpdateDate: | 04/16/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 41222 | AZ | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 41222 | 01 | AZ | STATE MEDICAL BOARD | OTHER |