Basic Information
| Provider Information | |||||||||
| NPI: | 1447214176 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCGRAHAM | ||||||||
| FirstName: | BETHANY | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 WERNER ST | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719136406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016221043 | ||||||||
| FaxNumber: | 5016221199 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 WERNER ST | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719136406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016221043 | ||||||||
| FaxNumber: | 5016221199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2006 | ||||||||
| LastUpdateDate: | 10/31/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | E-0400 | AR | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5J6686972 | 01 | AR | MEDICARE LINKED | OTHER |