Individual
DR. WALTER MAITLAND GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
32 S 150 E, BURLEY, ID 83318-5450
(208) 677-3034
(208) 677-2483
Mailing address
1501 HILAND AVE, STE. L2, BURLEY, ID 83318-2682
(208) 677-3034
(208) 677-2483
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M5964
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010002084
REGENCE BLUESHIELD
ID
01
—
5964-2
BLUE CROSS
ID
05
—
P318303
—
ID
Enumeration date
06/14/2006
Last updated
02/26/2024
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