Individual
TODD LEE GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BHRS
Contact information
Practice address
721 S GEORGE NIGH EXPY, MCALESTER, OK 74501-7400
(405) 208-1494
(918) 302-0405
Mailing address
721 S GEORGE NIGH EXPY, MCALESTER, OK 74501-7400
(405) 208-1494
(918) 302-0405
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100746580A
—
OK
Enumeration date
09/30/2011
Last updated
09/30/2011
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