NPIMap

Organization Active NPI

Graham Medical Clinic

  • Internal Medicine Physician
  • Graham, WA
National Provider Identifier
1013905231
Registry record updated Nov 7, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD00032553 Issued in WA
Legal business name
GRAHAM MEDICAL CLINIC
Practice address
21120 Meridian Ave E
Graham, WA 98338-8254
Phone
(253) 847-9166
Fax
(253) 847-6406
NPI assigned
Oct 11, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Raouf F Maoud, MD
Title
Owner
Phone
(253) 847-9166

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X MD00032553 WA Primary

Addresses

Primary practice location

21120 Meridian Ave E
Graham, WA 98338-8254

Mailing address

PO Box 1188
Graham, WA 98338-1188
Phone (253) 847-9166

Other identifiers 1

IdentifierTypeStateIssuer
8176968MedicaidWA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194393600000",
    "number": "1013905231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1188",
            "city": "GRAHAM",
            "state": "WA",
            "postal_code": "983381188",
            "telephone_number": "253-847-9166",
            "fax_number": "253-847-6406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21120 MERIDIAN AVE E",
            "city": "GRAHAM",
            "state": "WA",
            "postal_code": "983388254",
            "telephone_number": "253-847-9166",
            "fax_number": "253-847-6406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAHAM MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-11",
        "last_updated": "2007-11-07",
        "status": "A",
        "authorized_official_last_name": "MAOUD",
        "authorized_official_first_name": "RAOUF",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "253-847-9166",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD00032553",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8176968",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Graham, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.