Individual
DR. JON WESSLEY GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1702 UNIVERSITY DR S, FARGO, ND 58103-4940
(701) 364-3000
(701) 364-8906
Mailing address
PO BOX 6001, FARGO, ND 58108-6001
(701) 364-3300
(701) 364-8906
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
12272
ND
207Y00000X
Otolaryngology Physician
ME39776
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
16842
—
ND
Enumeration date
05/27/2006
Last updated
07/11/2012
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