Individual
DR. TANITH M. GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2869 SW CHAMPLAIN DR, PORTLAND, OR 97205-5833
(503) 709-8787
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-1196
(601) 984-5939
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
09591
MS
207L00000X
Anesthesiology Physician
MD13201
OR
207LP2900X
Pain Medicine (Anesthesiology) Physician
MD13201
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02121230
—
MS
01
—
050032614
RR MEDICARE
OR
05
—
1037381
—
WA
05
—
117006
—
OR
05
—
7394381-00
—
MN
Enumeration date
02/28/2006
Last updated
01/18/2018
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