Active NPI 1083641062 Individual Practitioner Male Practitioner

Dr. Bradley Scott Graham , MD

Dermatology • Tyler, TX

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. Bradley Graham, MD is a certified Dermatology practicing in Tyler, TX. With approximately 36 years of clinical experience since graduating from University Of Texas Medical Branch At Galveston in 1990, Dr. Graham delivers high-quality medical care to the local community at 1367 DOMINION PLAZA.

Dr. Graham is affiliated with Oliver Street 5.01(A) Inc and accepts Medicare assignment.

Frequently performed procedures and clinical services include pathology examination of tissue using a microscope, intermediate complexity, pathology examination of tissue using a microscope, moderately low complexity, special stained specimen slides to identify organisms including interpretation and report. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

1367 Dominion Plaza

Tyler, TX 757031013

Telephone 9035346200

Associated Practice Facility / Clinic

🏢 Oliver Street Dermatology Asc Llc Facility NPI 1700822335

Medicare Profile & Education

Medical School

University Of Texas Medical Branch At Galveston

Graduation Year

1990

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Dermatology in Tyler, TX

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

36 Yrs +9.9 yrs vs City Avg

City Avg: 26.1 Yrs

State Avg: 20.2 Yrs

Regional Practice Density

18 Specialists

Practicing in Tyler, TX (1210 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

70.7% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Graham (36 Years) 36 Yrs

Tyler Specialty Average (26.1 Years) 26.1 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
88305 Pathology examination of tissue using a microscope, intermediate complexity	16,309	10,569	$237.21	$69.35
88304 Pathology examination of tissue using a microscope, moderately low complexity	854	772	$144.48	$42.05
88312 Special stained specimen slides to identify organisms including interpretation and report	544	439	$379.12	$109.95
88341 Special stained specimen slides to examine tissue	451	162	$280.30	$81.89
88342 Special stained specimen slides to examine tissue, initial procedure	417	388	$354.41	$103.37
88350 Antibody evaluation, each additional single antibody stain procedure	285	56	$387.00	$114.56
88300 Pathology examination of tissue using a microscope, limited examination	88	85	$56.00	$16.18
88346 Antibody evaluation, initial single antibody stain procedure	57	56	$509.00	$150.66
88313 Special stained specimen slides to examine tissue including interpretation and report	53	50	$282.00	$82.12
88331 Pathology examination of specimen during surgery, first tissue block	16	14	$343.00	$101.40

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
88305 Pathology examination of tissue using a microscope, intermediate complexity	16,627	10,945	$225.99	$65.52
17003 Destruction of precancer skin growth, 2-14 growths	1,257	231	$23.00	$6.52
88304 Pathology examination of tissue using a microscope, moderately low complexity	915	789	$137.30	$39.90
88312 Special stained specimen slides to identify organisms including interpretation and report	621	478	$367.85	$106.85
99213 Established patient office or other outpatient visit, typically 15 minutes	452	377	$297.00	$87.97
88342 Special stained specimen slides to examine tissue, initial procedure	346	327	$322.04	$94.61
88341 Special stained specimen slides to examine tissue	336	150	$267.08	$78.56
17000 Destruction of skin growth	316	277	$223.00	$46.51
88350 Antibody evaluation, each additional single antibody stain procedure	316	63	$385.00	$112.45
17110 Destruction of up to 14 skin growths	225	212	$378.00	$108.92
88300 Pathology examination of tissue using a microscope, limited examination	113	99	$54.00	$15.50
11102 Tangential biopsy of single skin lesion	94	87	$338.00	$78.50
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	94	18	$24.00	$1.06
88313 Special stained specimen slides to examine tissue including interpretation and report	68	61	$269.85	$77.87
88346 Antibody evaluation, initial single antibody stain procedure	63	63	$502.00	$146.75
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	58	50	$420.00	$122.82
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	31	31	$369.00	$106.87
17004 Destruction of precancer skin growth, 15 or more growths	26	25	$562.00	$164.79
11103 Biopsy of related skin growth, each additional growth	19	12	$168.00	$49.11
11200 Removal of skin tag, 1-15 skin tags	16	16	$304.00	$55.72

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
88305 Pathology examination of tissue using a microscope, intermediate complexity	14,696	9,712	$220.70	$64.57
17003 Destruction of precancer skin growth, 2-14 growths	2,821	382	$23.00	$6.66
99213 Established patient office or other outpatient visit, typically 15 minutes	1,032	630	$295.00	$88.26
88304 Pathology examination of tissue using a microscope, moderately low complexity	773	689	$132.12	$39.03
17000 Destruction of skin growth	696	474	$221.00	$46.84
88312 Special stained specimen slides to identify organisms including interpretation and report	550	462	$362.11	$107.40
17110 Destruction of up to 14 skin growths	526	396	$374.00	$110.05
88342 Special stained specimen slides to examine tissue, initial procedure	325	312	$316.45	$94.24
88341 Special stained specimen slides to examine tissue	298	146	$265.59	$78.85
11102 Tangential biopsy of single skin lesion	231	195	$338.00	$82.56
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	202	32	$24.00	$1.13
88350 Antibody evaluation, each additional single antibody stain procedure	155	31	$385.00	$116.19
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	130	112	$416.00	$125.18
88300 Pathology examination of tissue using a microscope, limited examination	98	94	$50.00	$14.72
17004 Destruction of precancer skin growth, 15 or more growths	87	66	$554.00	$165.38
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	73	73	$365.00	$106.67
88313 Special stained specimen slides to examine tissue including interpretation and report	65	53	$262.20	$77.11
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	43	20	$47.00	$14.02
11103 Biopsy of related skin growth, each additional growth	41	33	$169.00	$49.56
88346 Antibody evaluation, initial single antibody stain procedure	31	31	$499.00	$150.69
Q0112 All potassium hydroxide (koh) preparations	30	28	$19.00	$5.75
J0702 Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg	25	12	$23.00	$6.70
11200 Removal of skin tag, 1-15 skin tags	24	23	$296.00	$60.62
11900 Injection into skin growth, 1-7 growths	21	13	$186.00	$37.07
69100 Biopsy of ear	20	20	$319.00	$63.47
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	15	14	$184.00	$54.91

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
88305 Pathology examination of tissue using a microscope, intermediate complexity	14,048	9,556	$219.40	$64.26
17003 Destruction of precancer skin growth, 2-14 growths	2,909	390	$21.16	$6.36
99213 Established patient office or other outpatient visit, typically 15 minutes	1,004	605	$288.76	$88.93
17000 Destruction of skin growth	682	460	$212.78	$45.54
88304 Pathology examination of tissue using a microscope, moderately low complexity	659	584	$127.25	$38.54
88312 Special stained specimen slides to identify organisms including interpretation and report	582	467	$352.60	$105.21
17110 Destruction of up to 14 skin growths	492	376	$365.33	$109.20
88341 Special stained specimen slides to examine tissue	376	170	$269.23	$82.18
11102 Tangential biopsy of single skin lesion	271	233	$334.16	$83.01
88342 Special stained specimen slides to examine tissue, initial procedure	271	255	$326.87	$99.00
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	224	31	$23.97	$1.27
88350 Antibody evaluation, each additional single antibody stain procedure	195	39	$349.00	$106.30
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	103	87	$408.88	$125.53
88300 Pathology examination of tissue using a microscope, limited examination	97	93	$50.01	$14.71
17004 Destruction of precancer skin growth, 15 or more growths	92	69	$527.28	$162.08
88313 Special stained specimen slides to examine tissue including interpretation and report	89	67	$254.25	$74.52
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	79	79	$358.21	$109.20
11103 Biopsy of related skin growth, each additional growth	60	50	$171.07	$51.73
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	56	48	$178.12	$54.77
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	54	18	$46.70	$13.80
88346 Antibody evaluation, initial single antibody stain procedure	39	39	$460.00	$140.19
J0702 Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg	35	11	$22.95	$6.77
Q0112 All potassium hydroxide (koh) preparations	27	27	$18.99	$5.83
11900 Injection into skin growth, 1-7 growths	25	16	$180.57	$37.51
11200 Removal of skin tag, 1-15 skin tags	20	20	$290.00	$52.66
69100 Biopsy of ear	18	18	$320.00	$72.81
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	17	17	$575.00	$174.90

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
88305 Pathology examination of tissue using a microscope, intermediate complexity	13,390	8,975	$163.47	$62.96
17003 Destruction of precancer skin growth, 2-14 growths	2,860	378	$17.53	$5.88
17000 Destruction of skin growth	652	450	$156.97	$44.08
99213 Established patient office or other outpatient visit, typically 15 minutes	603	438	$181.43	$73.20
88304 Pathology examination of tissue using a microscope, moderately low complexity	578	519	$92.20	$37.58
88312 Special stained specimen slides to identify organisms including interpretation and report	507	421	$245.79	$100.91
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	436	357	$258.76	$106.40
17110 Destruction of up to 14 skin growths	433	343	$266.97	$107.91
11102 Tangential biopsy of single skin lesion	274	219	$241.44	$80.99
88341 Special stained specimen slides to examine tissue	264	113	$221.15	$85.95
88342 Special stained specimen slides to examine tissue, initial procedure	210	202	$254.55	$99.85
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	209	31	$18.77	$1.45
88350 Antibody evaluation, each additional single antibody stain procedure	195	38	$177.13	$88.75
17004 Destruction of precancer skin growth, 15 or more growths	124	86	$387.50	$155.12
88300 Pathology examination of tissue using a microscope, limited examination	111	105	$37.33	$15.06
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	96	77	$108.29	$44.22
88313 Special stained specimen slides to examine tissue including interpretation and report	89	76	$180.83	$73.18
11103 Biopsy of related skin growth, each additional growth	74	47	$139.93	$51.53
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	60	21	$41.65	$13.92
88346 Antibody evaluation, initial single antibody stain procedure	39	38	$252.72	$120.90
J0702 Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg	37	13	$17.03	$7.03
Q0112 All potassium hydroxide (koh) preparations	29	27	$14.69	$5.81
36415 Insertion of needle into vein for collection of blood sample	21	16	$7.43	$2.98
11900 Injection into skin growth, 1-7 growths	20	14	$133.20	$47.12
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	20	17	$433.20	$160.44
69100 Biopsy of ear	20	18	$231.15	$72.12
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	19	19	$283.68	$105.35
99202 New patient office or other outpatient visit, typically 20 minutes	19	19	$175.39	$74.32
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	18	17	$386.44	$126.95
88321 Surgical pathology consultation and report on referred slides prepared elsewhere	13	13	$252.31	$99.73

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
88305 Pathology examination of tissue using a microscope, intermediate complexity	17,355	11,417	$135.06	$59.36
17003 Destruction of precancer skin growth, 2-14 growths	3,130	413	$13.92	$5.40
17000 Destruction of skin growth	759	487	$133.00	$46.35
99213 Established patient office or other outpatient visit, typically 15 minutes	738	498	$151.00	$71.68
88304 Pathology examination of tissue using a microscope, moderately low complexity	690	630	$80.72	$37.39
88312 Special stained specimen slides to identify organisms including interpretation and report	563	467	$195.49	$91.54
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	494	415	$221.00	$104.97
17110 Destruction of up to 14 skin growths	472	372	$226.00	$105.00
88341 Special stained specimen slides to examine tissue	347	146	$181.94	$85.50
11102 Tangential biopsy of single skin lesion	286	243	$202.00	$80.83
88342 Special stained specimen slides to examine tissue, initial procedure	279	261	$213.71	$100.31
88350 Antibody evaluation, each additional single antibody stain procedure	200	40	$157.00	$74.20
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	169	24	$11.24	$1.59
17004 Destruction of precancer skin growth, 15 or more growths	132	96	$311.00	$146.38
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	115	85	$92.00	$43.40
88300 Pathology examination of tissue using a microscope, limited examination	106	103	$32.00	$15.12
88313 Special stained specimen slides to examine tissue including interpretation and report	101	87	$148.00	$67.92
11103 Biopsy of related skin growth, each additional growth	52	44	$109.00	$51.12
88346 Antibody evaluation, initial single antibody stain procedure	40	40	$224.00	$105.55
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	35	11	$34.00	$16.07
11900 Injection into skin growth, 1-7 growths	31	17	$111.00	$47.29
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	28	28	$220.00	$104.74
69100 Biopsy of ear	26	26	$201.00	$78.27
99202 New patient office or other outpatient visit, typically 20 minutes	25	25	$155.00	$73.79
36415 Insertion of needle into vein for collection of blood sample	24	17	$6.00	$2.94
Q0112 All potassium hydroxide (koh) preparations	21	18	$12.00	$5.71
11200 Removal of skin tag, 1-15 skin tags	19	18	$181.00	$51.64
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	13	13	$361.00	$170.18
11104 Punch biopsy, first skin growth	11	11	$254.00	$119.10

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
88305 Pathology examination of tissue using a microscope, intermediate complexity	13,729	9,368	$204.41	$64.23
17003 Destruction of precancer skin growth, 2-14 growths	2,756	365	$37.39	$5.02
17000 Destruction of skin growth	656	427	$144.03	$45.41
99213 Established patient office or other outpatient visit, typically 15 minutes	640	439	$105.36	$70.20
88304 Pathology examination of tissue using a microscope, moderately low complexity	616	565	$143.91	$38.42
88312 Special stained specimen slides to identify organisms including interpretation and report	578	456	$142.70	$90.82
17110 Destruction of up to 14 skin growths	461	363	$195.68	$105.92
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	403	347	$156.42	$104.03
88341 Special stained specimen slides to examine tissue	332	124	$158.74	$88.48
88342 Special stained specimen slides to examine tissue, initial procedure	263	228	$183.82	$99.16
11100 Biopsy of single growth of skin and/or tissue	219	188	$185.17	$82.45
88350 Antibody evaluation, each additional single antibody stain procedure	217	42	$181.95	$69.36
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	166	28	$9.12	$1.79
88313 Special stained specimen slides to examine tissue including interpretation and report	99	84	$104.98	$66.49
88300 Pathology examination of tissue using a microscope, limited examination	93	91	$32.26	$15.61
17004 Destruction of precancer skin growth, 15 or more growths	92	60	$377.20	$137.81
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	73	58	$68.50	$41.67
88346 Antibody evaluation, initial single antibody stain procedure	56	43	$181.95	$88.03
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	41	12	$48.00	$19.61
11900 Injection into skin growth, 1-7 growths	40	20	$100.59	$47.30
11101 Biopsy of each additional growth of skin and/or tissue	40	33	$85.65	$30.95
36415 Insertion of needle into vein for collection of blood sample	36	17	$20.57	$2.94
11200 Removal of skin tag, 1-15 skin tags	29	28	$151.91	$51.91
99202 New patient office or other outpatient visit, typically 20 minutes	27	27	$116.66	$72.17
87220 Tissue fungi or parasites	23	20	$22.00	$5.16
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	23	23	$174.25	$104.03
88321 Surgical pathology consultation and report on referred slides prepared elsewhere	17	17	$181.17	$100.20
69100 Biopsy of ear	13	13	$196.11	$70.58

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
88305 Pathology examination of tissue using a microscope, intermediate complexity	15,561	10,247	$191.63	$57.68
17003 Destruction of precancer skin growth, 2-14 growths	2,646	384	$37.39	$5.22
99213 Established patient office or other outpatient visit, typically 15 minutes	707	486	$105.36	$68.68
88304 Pathology examination of tissue using a microscope, moderately low complexity	689	643	$137.95	$35.13
88312 Special stained specimen slides to identify organisms including interpretation and report	684	542	$131.49	$83.71
17000 Destruction of skin growth	656	461	$144.03	$46.26
17110 Destruction of up to 14 skin growths	399	333	$195.68	$102.03
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	366	332	$156.42	$101.57
88342 Special stained specimen slides to examine tissue, initial procedure	298	239	$163.67	$89.04
88350 Antibody evaluation, each additional single antibody stain procedure	267	57	$181.95	$67.43
11100 Biopsy of single growth of skin and/or tissue	225	206	$185.17	$83.69
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	161	31	$9.12	$1.80
88341 Special stained specimen slides to examine tissue	155	51	$154.14	$82.13
88300 Pathology examination of tissue using a microscope, limited examination	117	114	$31.27	$14.41
17004 Destruction of precancer skin growth, 15 or more growths	97	61	$377.20	$137.56
88313 Special stained specimen slides to examine tissue including interpretation and report	76	66	$99.12	$61.33
88346 Antibody evaluation, initial single antibody stain procedure	75	57	$181.95	$87.27
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	50	47	$69.87	$40.92
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	47	15	$48.00	$23.63
11200 Removal of skin tag, 1-15 skin tags	40	37	$151.91	$55.87
11101 Biopsy of each additional growth of skin and/or tissue	39	32	$85.65	$30.78
11900 Injection into skin growth, 1-7 growths	33	21	$100.59	$38.75
99202 New patient office or other outpatient visit, typically 20 minutes	33	33	$116.66	$70.36
69100 Biopsy of ear	24	21	$196.11	$68.44
87220 Tissue fungi or parasites	24	20	$22.00	$5.74
88331 Pathology examination of specimen during surgery, first tissue block	17	12	$255.65	$91.56
36415 Insertion of needle into vein for collection of blood sample	16	12	$20.57	$2.94
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	12	12	$174.25	$101.63

Medical Specialties & State Licenses

Dermatology Primary Specialty

NUCC Taxonomy Code: 207N00000X

State License TX L1869

A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.

Dermatology - Dermatopathology

NUCC Taxonomy Code: 207ND0900X

State License TX L1869

A dermatopathologist has the expertise to diagnose and monitor diseases of the skin including infectious, immunologic, degenerative and neoplastic diseases. This entails the examination and interpretation of specially prepared tissue sections, cellular scrapings and smears of skin lesions by means of routine and special (electron and fluorescent) microscopes.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID

145796201 (TX)

Commercial Insurance / Payer ID Blue Cross And Blue Shield Pathology

8865K2 (TX)

Commercial Insurance / Payer ID Railroad Medicare Ptan

070016784 (TX)

Commercial Insurance / Payer ID Blue Cross And Blue Shield Clinic

8A2682 (TX)

Hospital & Practice Group Affiliations

Oliver Street 5.01(A) Inc

3807 Spicewood Springs Rd, Austin, TX 787598966

Phone: 5124769195

Oliver Street 5.01(A) Inc

1329 S Sangre Rd, Stillwater, OK 740741854

Phone: 4055333376

Oliver Street 5.01(A) Inc

1367 Dominion Plz, Tyler, TX 757031013

Phone: 9035346200

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

20 Associated Practitioners

Dr. Shanna Meads , MD

Dermatology

NPI 1023054624

Doctor of Medicine (M.D.)

John Campbell , FNP

Nurse Practitioner

NPI 1043252174

Family Nurse Practitioner

Dr. Stephen Beck , MD

Dermatology - MOHS-Micrographic Surgery

NPI 1063490472

Doctor of Medicine (M.D.)

Brit Hatch , PA-C

Physician Assistant

NPI 1073934568

Physician Assistant (Certified)

Dr. Alma Berlingeri Ramos , MD

Dermatology

NPI 1083818884

Doctor of Medicine (M.D.)

Dr. Elizabeth Morris , MD

Dermatology

NPI 1134156102

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events

✅

NPI Profile Active May 22, 2008

NPI status registered as active in NPPES database

📍

Updated Practice Location May 22, 2008

Registered at 1367 DOMINION PLAZA, TYLER, TX 757031013 (Tel: 9035346200)

📍

Updated Business Mailing Address May 22, 2008

Registered at 1367 DOMINION PLAZA, TYLER, TX 757031013

👤

Provider Name / Credentials Updated May 22, 2008

Recorded as BRADLEY GRAHAM, MD

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) May 22, 2008

Dermatology (License #L1869 in TX)

🟢

Initial NPI Registration & Enumeration June 27, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1083641062

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: June 27, 2006

Last Update: May 22, 2008

Sole Proprietor: No

Update or Correct Profile

Mailing Address

1367 Dominion Plaza

Tyler, TX 757031013

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.