Individual
DR. TRAVIS S GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
707 SHERIDAN AVE, CODY, WY 82414-3409
(307) 578-2372
Mailing address
2420 INA AVE, CODY, WY 82414-9825
(307) 578-2372
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
43592
CO
2085R0202X
Diagnostic Radiology Physician
Primary
7334A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121621000
—
WY
01
—
P00324453
RR MEDICARE
WY
Enumeration date
03/14/2006
Last updated
08/05/2009
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