Basic Information
| Provider Information | |||||||||
| NPI: | 1538177407 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRAHAM | ||||||||
| FirstName: | IRENE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 S GRAND BLVD | ||||||||
| Address2: | DRC 1ST FLOOR | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631041015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149776333 | ||||||||
| FaxNumber: | 3149776340 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 S GRAND BLVD | ||||||||
| Address2: | DRC 1ST FLOOR | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631041015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149776333 | ||||||||
| FaxNumber: | 3149776340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 02/20/2009 | ||||||||
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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 | 207RI0200X | R1F55 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.