Provider Demographics
NPI:1528716297
Name:GRAHAM, MATTHEW J (DO)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
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:SAN ANTONIO MILITARY MEDICAL CENTER, MCHE-ZDM, INTERNAL
Mailing Address - Street 2:3551 ROGER BROOKE DR.
Mailing Address - City:JBSA-FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4504
Mailing Address - Country:US
Mailing Address - Phone:210-292-7805
Mailing Address - Fax:210-292-7868
Practice Address - Street 1:SAN ANTONIO MILITARY MEDICAL CENTER, MCHE-ZDM, INTERNAL
Practice Address - Street 2:3551 ROGER BROOKE DR.
Practice Address - City:JBSA-FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-292-7805
Practice Address - Fax:210-292-7868
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-12
Last Update Date:2024-03-21
Deactivation Date:2022-03-12
Deactivation Code:
Reactivation Date:2022-03-28
Provider Licenses
StateLicense IDTaxonomies
VA0102208207208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty