Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. JACKIE LYNN GRAHAM IV, M.D.
ActiveDR. JACKIE LYNN GRAHAM IV, M.D. is a Dermatology healthcare provider located in ROSWELL, New Mexico. NPI 1497851166 is currently active in the NPPES registry. Verify at CMS.
Dermatology · ROSWELL, NM
Registration Details
- NPI Number
- 1497851166
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Sep 16, 2006 (19.927439863016 yrs)
- Last Updated
- Jul 8, 2008
- License
-
74-39 (NM)
Practice Information
- Address
-
1600 SE MAIN ST STE EROSWELL, NM, 882035423Browse NM providers · Browse ZIP 88203
- Phone
- 5056238100
- Fax
- 5056238101
- Primary Specialty
-
Dermatology
207N00000X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.