JACK L GRAHAM, MD, PC (NPI# 1285730952) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285730952 |
| Entity Type | Organization |
| Organization Name | JACK L GRAHAM, MD, PC |
| Practice Address |
1600 Se Main St Ste E Roswell NM 88203-5423 |
| Practice Telephone | 5056238100 |
| Practice Fax Number | 5056238101 |
| Mailing Telephone | 5056238100 |
| Mailing Fax Number | 5056238101 |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2008-07-11 |
| Authorized Official Name | JACK LYNN GRAHAM (OWNER) |
| Authorized Official Telephone | 5056238100 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | 74-39 | NM | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NM | 11023 | 05 |
| Street Address |
1600 SE MAIN ST STE E |
| City | ROSWELL |
| State | NM |
| Zip Code | 88203-5423 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497851166 | Jackie Lynn Graham Iv | Dermatology | 1600 Se Main St Ste E, Roswell, NM 88203-5423 | 2006-09-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770115586 | Katherine Bolin | Behavior Technician | 333 West Brasher Rd. #200, Roswell, NM 88203 | 2020-02-10 |
| 1437660040 | Pecos Valley Eye Surgery Center, LLC | Clinic/Center | 1610 Se Main Street, Roswell, NM 88203 | 2017-10-23 |
| 1285031286 | Wheelchair and Walker Rentals, Inc. | Durable Medical Equipment & Medical Supplies | 305 W Mcgaffey St, Roswell, NM 88203 | 2014-11-20 |
| 1447585914 | Whole World Health Care, PC | Pediatrics | 109 W. Bland, Roswell, NM 88203 | 2009-10-16 |
| 1780825372 | Complete Rehab Adult Services | Clinic/Center | 109 W Bland, Roswell, NM 88203 | 2009-03-12 |
| 1710127220 | Roswell Medical Care | Health Maintenance Organization | 111 W Hobbs, Roswell, NM 88203 | 2009-02-23 |
| 1336330513 | Savitri Aguiar | Internal Medicine | 1511 South Grand, Roswell, NM 88203 | 2007-08-05 |
| 1750455523 | Francisco Casio Bicol Jr. | Occupational Therapist | 200 W 1st St Ste 527, Roswell, NM 88203 | 2006-11-20 |
| 1699861542 | Susan Lee Voigt | Counselor | 200 W 1st, Ste 532, Roswell, NM 88203 | 2006-10-05 |
| 1245336940 | Founders Healthcare LLC | Durable Medical Equipment & Medical Supplies | 104 N Missouri Ave, Roswell, NM 88203 | 2006-09-16 |
| Find all providers in zip 88203 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003479254 | Kiley Katherine Fagan | Dermatology | 775 Aronson Lake Ct, Roswell, GA 30075-7172 | 2019-04-15 |
| 1194209163 | Live Oak Dermatology | Dermatology | 135 Norcross St # 8, Roswell, GA 30075-3867 | 2018-09-17 |
| 1346503810 | Shaanan Satish Shetty | Dermatology | 1265 Upper Hembree Rd Ste 100, Roswell, GA 30076-1258 | 2012-06-20 |
| 1407075880 | Marcus Brian Goodman | Dermatology | 2500 Hospital Blvd Ste 280, Roswell, GA 30076-4918 | 2007-04-24 |
| 1568556017 | John C Henry | Dermatology | 207 N. Union, Suite C, Roswell, NM 88201 | 2006-10-02 |
| 1902842214 | Harry R. Mccarthy Jr. | Dermatology | 600 Currin Ct, Roswell, GA 30076-3583 | 2006-06-22 |
| 1447259577 | Kenneth Mark Ellner | Dermatology | 1265 Upper Hembree Rd, Suite 100, Roswell, GA 30076-1143 | 2005-07-20 |
| 1265927230 | Jennifer Erin Millsap | Dermatology | 415 E Crossville Rd, Roswell, GA 30075-7626 | 2018-06-22 |
| 1174916365 | Alexandria Bass Glass | Dermatology | 2500 Hospital Blvd Ste 280, Roswell, GA 30076-4918 | 2015-03-11 |
| 1326357799 | Eugene Sanik | Dermatology | 2500 Hospital Blvd, Suite 280, Roswell, GA 30076-4907 | 2010-10-01 |
| Find all providers in ROSWELL | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.