Provider Demographics
NPI:1386759264
Name:GRAHAM, DAVID BUOY (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BUOY
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 19670
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62794-9670
Mailing Address - Country:US
Mailing Address - Phone:217-757-8100
Mailing Address - Fax:217-747-1351
Practice Address - Street 1:520 NORTH 4TH STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62794-9670
Practice Address - Country:US
Practice Address - Phone:217-757-8100
Practice Address - Fax:217-747-1351
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2020-10-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO43056207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036119713Medicaid
G82510Medicare UPIN
ILK49642Medicare PIN