Provider Demographics
NPI:1962425868
Name:GRAHAM, DAVID M (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:GRAHAM
Suffix:
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 1:2900 12TH AVE N
Mailing Address - Street 2:STE 500E
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-7500
Mailing Address - Country:US
Mailing Address - Phone:406-238-6800
Mailing Address - Fax:
Practice Address - Street 1:2900 12TH AVE N
Practice Address - Street 2:300E
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-7506
Practice Address - Country:US
Practice Address - Phone:406-238-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10910207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0150535OtherMDCD PIN
MT000092176OtherBCBS PIN
MT000085130Medicare PIN
MT000092176OtherBCBS PIN
I49797Medicare UPIN
MT011001317Medicare PIN
MT0150535OtherMDCD PIN
MT1153260003Medicare PIN