Individual
DR. PAUL M GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO, FAAD
Contact information
Practice address
305 CLYDE MORRIS BLVD STE 150, ORMOND BEACH, FL 32174-8186
(386) 615-1771
(386) 615-1545
Mailing address
305 CLYDE MORRIS BLVD STE 150, ORMOND BEACH, FL 32174-8186
(386) 615-1771
(386) 615-1545
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
OS15142
FL
207ND0101X
MOHS-Micrographic Surgery Physician
OS15142
FL
207NP0225X
Pediatric Dermatology Physician
OS15142
FL
207NS0135X
Procedural Dermatology Physician
OS15142
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
107214900
—
FL
Enumeration date
03/30/2014
Last updated
01/24/2023
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