Provider Demographics
NPI:1992954416
Name:GRAHAM, ROBERT WESLEY (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:WESLEY
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 N TUSCOLA RD
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-6961
Mailing Address - Country:US
Mailing Address - Phone:989-892-9595
Mailing Address - Fax:
Practice Address - Street 1:116 N TUSCOLA RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-6961
Practice Address - Country:US
Practice Address - Phone:989-892-9595
Practice Address - Fax:989-892-8930
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017666207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology