Individual
JOSEPH A GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1340 BROAD AVENUE, SUITE 220, GULFPORT, MS 39501
(228) 575-1300
(228) 867-6423
Mailing address
PO BOX 1810, GULFPORT, MS 39502-1810
(228) 575-1300
(228) 867-6423
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
059594
FL
2086S0129X
Vascular Surgery Physician
Primary
20350
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
276169600
—
FL
01
—
2977616
CIGNA PROVIDER #
FL
05
—
5108802
—
MS
01
—
53064
BCBS PROVIDER #
FL
01
—
7616821
AETNA PROVIDER #
FL
Enumeration date
05/03/2006
Last updated
07/10/2014
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