Individual
DR. SCOTT MICHAEL GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
24331 EL TORO RD STE 200, LAGUNA WOODS, CA 92637-3116
(949) 586-3200
(949) 900-2136
Mailing address
24331 EL TORO RD STE 200, LAGUNA WOODS, CA 92637-3116
(949) 586-3200
(949) 900-2136
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
A61526
CA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
A61526
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A615260
—
CA
01
—
00A615260G89
CAL-OPTIMA
CA
01
—
RR2000 42895
MEDICARE RAILROAD
CA
Enumeration date
05/27/2005
Last updated
10/16/2023
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