Provider Demographics
NPI:1831325463
Name:GRAHAM, DUSTIE LEIGH (LMT)
Entity type:Individual
Prefix:
First Name:DUSTIE
Middle Name:LEIGH
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2529 W BUSCH BLVD
Mailing Address - Street 2:STE 600
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-4545
Mailing Address - Country:US
Mailing Address - Phone:813-443-5179
Mailing Address - Fax:813-443-5122
Practice Address - Street 1:2529 W BUSCH BLVD
Practice Address - Street 2:STE 600
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-4545
Practice Address - Country:US
Practice Address - Phone:813-443-5179
Practice Address - Fax:813-443-5122
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA55804175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath