Jack L Graham, Md, Pc

LBN: Jack L Graham, Md, Pc
Jack L Graham, Md, Pc is an health care organization with primary practice located at 1600 Se Main St Ste E , Roswell NM 88203-5423. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as the primary health care specialty. Jack L Graham, Md, Pc can be contacted via phone (505) 623-8100, or through Graham, Jack Lynn via phone (505) 623-8100.

Contact Information

Primary practice address
1600 Se Main St Ste E Roswell NM 88203-5423
Phone: (505) 623-8100
Fax: (505) 623-8101
Website:
Map and Directions
Authorized official contact:
Name: Graham, Jack Lynn Doctor of Medicine (MD)
Phone: (505) 623-8100

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 74-39 New Mexico

Profile Details

NPI number 1285730952
LBN Legal business name Jack L Graham, Md, Pc
DBA Doing business as
Authorized official Graham, Jack Lynn Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Sep 16th, 2006
Last updated Jul 11th, 2008 - about 17 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1285730952 NPPES
New Mexico MEDICAID 11023

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