Individual
BRADLEY SCOTT GRAHAM
Active
Individual
BRADLEY SCOTT GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
L1869
TX
207ND0900X
Dermatopathology Physician
L1869
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070016784
RAILROAD MEDICARE PTAN
TX
05
—
145796201
—
TX
01
—
8865K2
BLUE CROSS AND BLUE SHIELD PATHOLOGY
TX
01
—
8A2682
BLUE CROSS AND BLUE SHIELD CLINIC
TX
Enumeration date
06/27/2006
Last updated
05/22/2008
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