# PERINATAL MEDICINE ASSOCIATES, LLP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972679322
- **Authorized official:** DR. JACK MONROE GRAHAM MD (MD)
- **Authorized official phone:** (817) 481-0111

## Contact information

- **Practice address:** 1600 W COLLEGE ST, SUITE 210, GRAPEVINE, TX 76051-3580
- **Practice address phone:** (817) 481-0111
- **Practice address fax:** (817) 481-0112
- **Mailing address:** PO BOX 100186, FORT WORTH, TX 76185-0186
- **Mailing address phone:** (817) 731-7771
- **Mailing address fax:** (817) 731-7774

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207VM0101X | Maternal & Fetal Medicine Physician | — | NULL | Yes |
| 207VM0101X | Maternal & Fetal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/28/2006
- **Last updated:** 04/22/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0071JQ | BCBS | TX |
| 01 | — | 10004902 | AMERIGROUP | TX |
| 05 | — | 156095501 | — | TX |
| 05 | — | 156095502 | — | TX |