Provider Demographics
NPI:1023113461
Name:DAVID S GRAUMAN MD PC
Entity type:Organization
Organization Name:DAVID S GRAUMAN MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:GRAUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PC, MRO
Authorized Official - Phone:907-456-2825
Mailing Address - Street 1:1919 LATHROP ST STE 203
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-5943
Mailing Address - Country:US
Mailing Address - Phone:907-456-2825
Mailing Address - Fax:907-451-0742
Practice Address - Street 1:1919 LATHROP ST STE 203
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5943
Practice Address - Country:US
Practice Address - Phone:907-456-2825
Practice Address - Fax:907-451-0742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKC97097Medicare UPIN
AKF32383Medicare UPIN
AKR14829Medicare UPIN