Oswald Calvin Graham, MD
Individual provider Active NPI Family Medicine Physician · Cloris, NM
NPI 1922188457 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1922188457
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 8154 (NM)
- Practice address
- 814 West 21St St
Cloris, NM 88101 - Phone
- (505) 769-2674
- Fax
- (505) 762-9304
- NPI assigned
- Oct 17, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8154 | NM | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 8154 | NM | Yes |
Addresses
Primary practice location
814 West 21St St
Cloris, NM 88101
Mailing address
814 West 21St St
Cloris, NM 88101
Phone (505) 769-2674
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NM001109 | Other | BCBS | |
| 0003798 | Medicaid | NM |
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.