Individual
BRENT GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
15770 PAUL VEGA MD DR STE 108A, HAMMOND, LA 70403-1475
(985) 230-1870
(985) 230-7461
Mailing address
49427 TULLOS RD, FRANKLINTON, LA 70438-3855
(985) 515-9751
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
231115
LA
Other
Enumeration date
07/19/2023
Last updated
08/11/2023
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