Provider Demographics
NPI:1699766881
Name:GRAHAM, DAVID W JR (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:GRAHAM
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 LAKELAND HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-3019
Mailing Address - Country:US
Mailing Address - Phone:863-680-7000
Mailing Address - Fax:866-264-8519
Practice Address - Street 1:1730 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3013
Practice Address - Country:US
Practice Address - Phone:863-680-7780
Practice Address - Fax:866-264-8519
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 880012085R0001X
MS221742085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00087582OtherMEDICARE RAILROAD
FL274780400Medicaid
FL274780400Medicaid
FLP00087582OtherMEDICARE RAILROAD