DR. JACKIE LYNN GRAHAM IV M.D.
NPI 1497851166
Dermatology in Roswell, NM

Active since September 16, 2006
1600 SE MAIN ST STE E, ROSWELL, NM 88203(505) 623-8100(505) 623-8101 Get Directions Write a Review

NPPES record last updated: July 8, 2008. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Dr. Jackie Lynn Graham Iv M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JACKIE LYNN GRAHAM IV M.D. (NPI 1497851166) is an individual dermatology provider in Roswell, New Mexico, licensed in New Mexico (74-39) and active in the NPI registry since September 2006.

NPPES Registry Identity

NPI1497851166
Entity TypeIndividualMale
Primary Taxonomy207N00000X
Provider Legal NameDR. JACKIE LYNN GRAHAM IVCredential: M.D.
Location Address1600 SE MAIN ST STE ERoswell, NM 88203-5423
Mailing Address1600 Se Main St Ste ERoswell, NM 88203-5423 · (505) 623-8100 · Fax (505) 623-8101
Fax(505) 623-8101
Sole ProprietorNo
Enumeration DateSeptember 16, 2006
Last NPPES UpdateJuly 8, 2008
NPI 1497851166 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
License Licensed in NM · 74-39
Definition
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.
1600 SE MAIN ST STE E, Roswell, NM 88203

Other Names 1

Professional Name (2)Dr. Jack L Graham M.d.

Other Identifiers 3

Medicare UPIND35666NM
Medicaid11023NM
Medicare PINNM00047NM

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Dermatology
1600 SE MAIN ST STE E
ROSWELL, NM 88203

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jackie Graham's NPI number?

The NPI number for Jackie Graham is 1497851166. It was assigned to this individual provider in the NPPES registry on September 16, 2006. The provider is also known as Dr. Jack L Graham M.D..

Where is Jackie Graham located?

Jackie Graham practices at 1600 SE Main St Ste E, Roswell, NM 88203. The listed phone number is (505) 623-8100.

What is Jackie Graham's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

When was this NPI record last updated?

The NPPES record for Jackie Graham was last updated on July 8, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.