Provider Demographics
NPI:1427452549
Name:LOYCE J. GRAHAM, M. D. PLLC
Entity type:Organization
Organization Name:LOYCE J. GRAHAM, M. D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOYCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-718-5328
Mailing Address - Street 1:18410 DONAHOE LN
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TX
Mailing Address - Zip Code:76511-4084
Mailing Address - Country:US
Mailing Address - Phone:254-527-3377
Mailing Address - Fax:
Practice Address - Street 1:181 TOWN CENTER BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:JARRELL
Practice Address - State:TX
Practice Address - Zip Code:76537-4001
Practice Address - Country:US
Practice Address - Phone:254-718-5328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1483261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care