Jack L Graham, MD, PC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

74-39 Issued in NM

Legal business name

JACK L GRAHAM, MD, PC

Practice address

1600 SE Main St Ste E
Roswell, NM 88203-5423

Phone

(505) 623-8100

Fax

(505) 623-8101

NPI assigned

Sep 16, 2006

Organization subpart

No

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

Authorized official

Name

Jack Lynn Graham, M.D.

Title

Owner

Phone

(505) 623-8100

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

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

• Barnie P. Rodriguez, P.A.

  • Physician Assistant
  • Roswell, NM
  • NPI 1639395221
  NPD (past)

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

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215734400000",
    "number": "1285730952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 SE MAIN ST STE E",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882035423",
            "telephone_number": "505-623-8100",
            "fax_number": "505-623-8101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 SE MAIN ST STE E",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882035423",
            "telephone_number": "505-623-8100",
            "fax_number": "505-623-8101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK L GRAHAM, MD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-16",
        "last_updated": "2008-07-11",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "505-623-8100",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "NM",
            "license": "74-39",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11023",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Industrial Rehabilitation Clinics, PC
• Kelly Isler, RPH
• Samuel Basiaka Itie, FNP-C
• Ivy League Counseling LLC
• Chuck Ivy, LCSW
• Holly M Jackson,, B.S.
• Brandon Jacobi, PHARMD
• Alan R Jakins, MD
• James E Lankford DDS PA
• James F. Van Pelt,III,M.D.,PHD, P.C.

• Dermatology Physician in Roswell, NM
• Providers in Roswell, NM by specialty
• Dermatology Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2008; 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.