Individual
LEON J. GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1800 12TH ST, MERIDIAN, MS 39301-4158
(601) 703-9687
(601) 703-4567
Mailing address
PO BOX 5183, MERIDIAN, MS 39302-5183
(601) 703-4282
(601) 703-4597
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
12841
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00116274
—
MS
05
—
009938765
—
AL
01
—
730-12797
BLUE CROSS OF AL
—
01
—
P00113829
RAILROAD MEDICARE
—
Enumeration date
11/18/2005
Last updated
11/09/2013
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