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Contact Information

BRADLEY S GRAHAM, MD
1367 DOMINION PLAZA
TYLER, TX75703-1013
 Phone: 903-534-6200
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dermatology

207N00000X 07 Physician/Dermatology
 

Dermatopathology

207ND0900X 07 Physician/Dermatology
Indicates primary specialty

NPI Profile & details for BRADLEY S GRAHAM · (Male)

NPI # 1083641062
Status Active
Credentials MD
Entity Individual
Enumeration date 06/27/2006
Last updated 05/22/2008 - About 18 years ago
Sole proprietor 1 No
Identifiers
  • TX License # L1869
  • TX Medicaid 145796201
  • TX Other 8A2682 BLUE CROSS AND BLUE SHIELD CLINIC
  • TX Other 8865K2 BLUE CROSS AND BLUE SHIELD PATHOLOGY
  • TX Other 070016784 RAILROAD MEDICARE PTAN
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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