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Organization
PERINATAL MEDICINE ASSOCIATES, LLP
Active
Organization
PERINATAL MEDICINE ASSOCIATES, LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK MONROE GRAHAM MD (MD)
(817) 481-0111
Entity
Organization
Contact information
Practice address
1600 W COLLEGE ST, SUITE 210, GRAPEVINE, TX 76051-3580
(817) 481-0111
(817) 481-0112
Mailing address
PO BOX 100186, FORT WORTH, TX 76185-0186
(817) 731-7771
(817) 731-7774
Taxonomy
Speciality
Code
Description
License number
State
207VM0101X
Maternal & Fetal Medicine Physician
Primary
—
NULL
207VM0101X
Maternal & Fetal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0071JQ
BCBS
TX
01
—
10004902
AMERIGROUP
TX
05
—
156095501
—
TX
05
—
156095502
—
TX
Enumeration date
11/28/2006
Last updated
04/22/2008
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