Provider Demographics
NPI:1306149083
Name:DRAYTON P GRAHAM A MEDICAL CORPORATION
Entity type:Organization
Organization Name:DRAYTON P GRAHAM A MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DRAYTON
Authorized Official - Middle Name:P
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:310-970-1930
Mailing Address - Street 1:4477 W 118TH ST STE 405
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-2259
Mailing Address - Country:US
Mailing Address - Phone:310-970-1930
Mailing Address - Fax:928-268-0107
Practice Address - Street 1:4477 W 118TH ST
Practice Address - Street 2:STE. 401
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2255
Practice Address - Country:US
Practice Address - Phone:310-970-1930
Practice Address - Fax:310-970-1979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-17
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27833207RP1001X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherNPI NUMBER FOR DRAYTON P. GRAHAM MD INC