Individual
GARY ROBERT GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2776 ENTERPRISE RD # 100, ORANGE CITY, FL 32763-8316
(386) 774-1223
(386) 774-4658
Mailing address
2776 ENTERPRISE RD # 100, ORANGE CITY, FL 32763-8316
(386) 774-1223
(386) 774-4658
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
ME68452
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
379101700
—
FL
Enumeration date
08/10/2005
Last updated
12/13/2017
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