Individual
CHARLES SCOTT GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
620 S J ST, LAKEVIEW, OR 97630-1680
(541) 947-2331
Mailing address
620 S J ST, LAKEVIEW, OR 97630-1680
(541) 947-2331
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO21658
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
133998
—
OR
Enumeration date
01/26/2007
Last updated
01/07/2020
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