Provider Demographics
NPI:1144539453
Name:GRAHAM, MORTON (RDCS, RVT)
Entity type:Individual
Prefix:MR
First Name:MORTON
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:RDCS, RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 863722
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75086-3722
Mailing Address - Country:US
Mailing Address - Phone:214-363-6611
Mailing Address - Fax:214-363-6851
Practice Address - Street 1:808 STONE TRAIL DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-7108
Practice Address - Country:US
Practice Address - Phone:214-363-6611
Practice Address - Fax:214-363-6851
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist Cardiovascular
No246W00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Cardiology
No246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular Specialist
No246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX088010601Medicaid
TX0092KYOtherBLUE CROSS BLUE SHIELD OF TX
TXFTCVU5Medicare UPIN