Individual
DR. LARRY C GRAHAM II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3600 E HARRY ST, WICHITA, KS 67218-3713
(316) 689-5050
(316) 689-6192
Mailing address
13715 PINNACLE DR, WICHITA, KS 67230-1545
(316) 733-2307
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
Primary
04-28763
KS
2085N0700X
Neuroradiology Physician
04-28763
KS
2085N0904X
Nuclear Radiology Physician
04-28763
KS
2085P0229X
Pediatric Radiology Physician
04-28763
KS
2085R0202X
Diagnostic Radiology Physician
04-28763
KS
2085R0203X
Therapeutic Radiology Physician
04-28763
KS
2085R0204X
Vascular & Interventional Radiology Physician
04-28763
KS
2085U0001X
Diagnostic Ultrasound Physician
04-28763
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100173090A
—
OK
05
—
100420330C
—
KS
05
—
1023090503
—
MO
01
—
300132252
RR MEDICARE
KS
Enumeration date
11/18/2005
Last updated
11/20/2013
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