Individual
SCOTT R GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
700 CASSIDY AVE, FREDONIA, KY 42411
(270) 545-3386
(270) 545-3712
Mailing address
PO BOX 195, 700 CASSIDY AVE, FREDONIA, KY 42411
(270) 545-3386
(270) 545-3712
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25831
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64258312
—
KY
Enumeration date
09/11/2006
Last updated
03/07/2023
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