Individual
SUSAN DIANE GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1010 THREE SPRINGS BLVD, DURANGO, CO 81301-8296
(303) 306-7783
(303) 306-7753
Mailing address
PO BOX 17752, DENVER, CO 80217-0752
(303) 306-7783
(303) 306-7753
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
35621
CO
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
35621
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000L3404
—
NM
05
—
01356211
—
CO
01
—
P00315470
RAILROAD MEDICARE PIN
CO
Enumeration date
07/27/2006
Last updated
03/24/2014
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