Individual
DR. CHARLES E GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6037 LA GRANADA PMB 1223, PMB 1223, RANCHO SANTA FE, CA 92067-1223
(858) 756-5475
(858) 756-7639
Mailing address
6037 LA GRANADA #1223, RANCHO SANTA FE, CA 92067-1223
(858) 756-5475
(858) 756-7639
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
C31279
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1962487728
NATIONAL PROVIDER INDENTIFIER
CA
01
—
C31279
STATE LICENSE
CA
Enumeration date
12/14/2005
Last updated
03/07/2023
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