Provider Demographics
NPI:1528135266
Name:STUART M. GRAHAM JR MD PL
Entity type:Organization
Organization Name:STUART M. GRAHAM JR MD PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:MALCOLM
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:561-775-9288
Mailing Address - Street 1:257 S BEACH RD
Mailing Address - Street 2:
Mailing Address - City:HOBE SOUND
Mailing Address - State:FL
Mailing Address - Zip Code:33455-2512
Mailing Address - Country:US
Mailing Address - Phone:772-546-0101
Mailing Address - Fax:561-624-4460
Practice Address - Street 1:11211 PROSPERITY FARMS RD
Practice Address - Street 2:SUITE D129 - OAKPARK
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-3446
Practice Address - Country:US
Practice Address - Phone:561-775-9288
Practice Address - Fax:561-624-4460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME37835207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty