Individual
ADAM W GRAHAM
Active
Individual
ADAM W GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
5703835-1206
UT
363AM0700X
Medical Physician Assistant
5703835-1206
UT
363AM0700X
Medical Physician Assistant
Primary
MT 503
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100505177
—
NV
01
—
13228
UNIVERSITY HEALTH PLANS
—
01
—
224848
ALTIUS #
—
01
—
80105
PEHP #
—
05
—
807004900
—
ID
Enumeration date
05/12/2006
Last updated
08/19/2010
Update your record
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