Provider Demographics
NPI:1215311998
Name:GRAHAM, RUDI-ANN TAMARA (MD)
Entity type:Individual
Prefix:DR
First Name:RUDI-ANN
Middle Name:TAMARA
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1444 NW 14TH AVE.
Mailing Address - Street 2:APARTMENT 1107
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125
Mailing Address - Country:US
Mailing Address - Phone:305-903-5650
Mailing Address - Fax:
Practice Address - Street 1:1444 NW 14TH AVE
Practice Address - Street 2:APARTMENT 1107
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1686
Practice Address - Country:US
Practice Address - Phone:305-903-5650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21979208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics