Provider Demographics
NPI:1992818041
Name:GRAHAM, BENJAMIN JR (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:GRAHAM
Suffix:JR
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 C STREET
Mailing Address - Street 2:MEDICAL STAFF OFFICE
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553
Mailing Address - Country:US
Mailing Address - Phone:925-370-5646
Mailing Address - Fax:925-370-5142
Practice Address - Street 1:331 C ST
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-3137
Practice Address - Country:US
Practice Address - Phone:925-370-5646
Practice Address - Fax:925-370-5142
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2025-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG35252207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G352520OtherMEDI-CAL
CAA46278Medicare UPIN
CA00G352520OtherMEDI-CAL