Basic Information
| Provider Information | |||||||||
| NPI: | 1841228640 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRAHAM | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3140 LEGACY DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750349566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729541469 | ||||||||
| FaxNumber: | 4692832743 | ||||||||
| Practice Location | |||||||||
| Address1: | 3140 LEGACY DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729541466 | ||||||||
| FaxNumber: | 4696563808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 12/27/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | J5991 | TX | N | Allopathic & Osteopathic Physicians | Anesthesiology | 208VP0014X | J5991 | TX | N | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 207LP2900X | J5991 | TX | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.