Provider Demographics
NPI:1538177407
Name:GRAHAM, IRENE L (MD)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:L
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1100 S GRAND BLVD
Mailing Address - Street 2:DRC 1ST FLOOR
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-1015
Mailing Address - Country:US
Mailing Address - Phone:314-977-6333
Mailing Address - Fax:314-977-6340
Practice Address - Street 1:1100 S GRAND BLVD
Practice Address - Street 2:DRC 1ST FLOOR
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1015
Practice Address - Country:US
Practice Address - Phone:314-977-6333
Practice Address - Fax:314-977-6340
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR1F55207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease