Individual
BILLY D GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C.
Contact information
Practice address
1 MEDICAL PLAZA DR, ROSEVILLE, CA 95661
(916) 781-1002
(916) 781-1003
Mailing address
10470 OLD PLACERVILLE RD STE 100, SACRAMENTO, CA 95827-2539
(800) 470-0071
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA15123
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00PA15123
—
CA
Enumeration date
10/10/2006
Last updated
09/17/2019
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