Individual
DR. JEAN GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4801 N BUTLER AVE, FARMINGTON, NM 87401-6002
(505) 324-8375
Mailing address
1654 COUNTY ROAD 120, HESPERUS, CO 81326-9752
(970) 259-7136
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
97-254
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
84-1497491-001
ROCKY MT HMO
CO
01
—
NM012425
BLUE CROSS BLUE SHIELD NM
NM
05
—
Q2833
—
NM
Enumeration date
12/21/2006
Last updated
07/08/2007
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