Individual
DR. BRENT A. GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9841 NW ASH ST, PORTLAND, OR 97229-6281
(503) 201-1120
Mailing address
9841 NW ASH ST, PORTLAND, OR 97229-6281
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD21539
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050069040
RR MEDICARE
OR
05
—
136220
—
OR
05
—
8239592
—
WA
05
—
MD464OR
—
AK
Enumeration date
02/28/2006
Last updated
12/14/2023
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