Individual
DAVID M GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3300 WELTY RD, LUCAS, OH 44843-9729
(419) 566-4152
(419) 842-3875
Mailing address
PO BOX 182255, COLUMBUS, OH 43218-2255
(614) 430-5764
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN179320
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000187657
ANTHEM
—
05
—
0751548
—
OH
01
—
430062331
MEDICARE RAILROAD
—
Enumeration date
05/15/2006
Last updated
07/23/2013
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