Individual
TED GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3134 BRIARCREST DR, BRYAN, TX 77802-3014
(979) 314-2323
Mailing address
4308 ODELL LN, COLLEGE STATION, TX 77845-7350
(910) 724-2194
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
200000436
NC
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
R0007
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
891261N
—
NC
Enumeration date
06/09/2006
Last updated
04/08/2020
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