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JACK M GRAHAM M.D. NPI 1205801347


NPI Information

NPI: 1205801347
Provider Name: JACK M GRAHAM, M.D.
Classification: Obstetrics & Gynecology - 207VM0101X
Entity Type: Individual

Specialization: Maternal & Fetal Medicine

PECOS Registration: Yes

Address:
1500 S MAIN ST
FORT WORTH, TX
ZIP 76104
Phone: (817) 702-1166
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Jack M Graham, M.D. is a maternal and fetal medicine obstetrics gynecology in Fort Worth, TX with 46 years of experience. The provider is an obstetrician/gynecologist who cares for, or provides consultation on, patients with complications of pregnancy. This specialist has advanced knowledge of the obstetrical, medical and surgical complications of pregnancy and their effect on both the mother and the fetus. The specialist also possesses expertise in the most current diagnostic and treatment modalities used in the care of patients with complicated pregnancies. Jack M Graham, M.D. NPI is 1205801347. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF TEXAS MEDICAL SCHOOL AT HOUSTON
Graduation Year:1978

The provider's business location address is:

1500 S MAIN ST
FORT WORTH, TX
ZIP 76104-917
Phone: (817) 702-1166
Fax: (817) 702-1405

The NPI 1205801347 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 2/22/2006 and was last updated on 12/28/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207V00000XObstetrics & GynecologyF1600TEXASNo
2207VM0101XObstetrics & GynecologyMaternal & Fetal MedicineF1600TEXASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1139366223MEDICAIDTEXAS
28H3360OTHERTEXASBCBS
3139366219MEDICAIDTEXAS
4139366218MEDICAIDTEXAS
54227216OTHERTEXASAETNA
610028874OTHERTEXASAMERIGROUP

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.