Individual
DR. STANLEY KEITH GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
506 4TH ST, LA GRANDE, OR 97850-1906
(541) 963-3138
(541) 963-5918
Mailing address
506 4TH ST, LA GRANDE, OR 97850-1906
(541) 963-3138
(541) 963-5918
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD15159
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
065268
—
OR
01
—
9305053253023
EMPLOYER ID
OR
01
—
H1395 01
PACIFIC SOURCE
OR
01
—
P00265707
RR MEDICARE
OR
Enumeration date
07/03/2006
Last updated
07/09/2007
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