Provider Demographics
NPI:1962542316
Name:GRAHAM, WILLIAM S JR (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:S
Last Name:GRAHAM
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:600 W COLLEGE ST STE 120
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65806-1201
Mailing Address - Country:US
Mailing Address - Phone:417-831-0022
Mailing Address - Fax:417-831-0451
Practice Address - Street 1:600 W COLLEGE ST STE 120
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65806-1201
Practice Address - Country:US
Practice Address - Phone:417-831-0022
Practice Address - Fax:417-831-0451
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2012-10-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO114654207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203756101Medicaid
MO116495OtherMO BLUE SHIELD
AR83834OtherARK BLUE SHIELD
MO116495OtherMO BLUE SHIELD
F40833Medicare UPIN