Individual
ERIC J GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15476 DEDEAUX RD, GULFPORT, MS 39503-2637
(228) 230-2663
(228) 679-3038
Mailing address
6300 E LAKE BLVD, SUITE 301, VANCLEAVE, MS 39565-6770
(228) 230-2663
(228) 206-1192
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
17733
MS
207X00000X
Orthopaedic Surgery Physician
Primary
17733
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00126157
—
MS
01
—
P00285790
RAILROAD MEDICARE
MS
Enumeration date
09/26/2006
Last updated
01/13/2023
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