Individual
ERIC KEVIN GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3801 WILLIAM D TATE AVE # 800A, GRAPEVINE, TX 76051-8755
(817) 488-8998
Mailing address
8173 MIDTOWN BLVD APT 3312, DALLAS, TX 75231-4493
(972) 322-1757
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1172707
NATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS
—
01
—
PA13678
TEXAS PHYSICIAN ASSISTANT BOARD
TX
Enumeration date
09/11/2020
Last updated
10/05/2020
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