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Individual

ADAM W GRAHAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
P.A.

Contact information

Practice address
12499 CLAIMSTAKE CT, LOLO, MT 59847-9435
(406) 493-8269
Mailing address
12499 CLAIMSTAKE CT, LOLO, MT 59847-9435
(406) 493-8269

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
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