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DR. LARRY C GRAHAM MD

Physicians Radiology Body Imaging

Provider NPI: 1023090503

Provider Information:
DR. LARRY C GRAHAM MD
Gender: M
Not Sole Proprietor

Practice Location:
3600 E HARRY ST  WICHITA, KS 67218-3713 US
Tel: 316-689-5050  Fax: 316-689-6192

Business Mailing Address:
13715 PINNACLE DR  WICHITA, KS 67230-1545 US
Tel: 316-733-2307  Fax: --

NPI Information:
NPI: 1023090503
Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y2085B0100XPhysicians
Radiology
Body Imaging
KS04-28763
N2085N0700XPhysicians
Radiology
KS04-28763
N2085N0904XPhysicians
Radiology
KS04-28763
N2085P0229XPhysicians
Radiology
KS04-28763
N2085R0202XPhysicians
Radiology
KS04-28763
N2085R0203XPhysicians
Radiology
KS04-28763
N2085R0204XPhysicians
Radiology
KS04-28763
N2085U0001XPhysicians
Radiology
KS04-28763

Other Provider Identifiers:

IssuerNumberStateType
100173090AOK05
1023090503MO05
RR MEDICARE300132252KS01
100420330CKS05



American Medical Association 2012 taxonomy code information

Code: 2085B0100X

Type:

Classification:



Definition:



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