Individual
DR. TRAVIS S GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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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