MEDICARE: BETTY CHUNG GRASTY MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	L1871	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0059JQ	OTHER		BCBS
2	R0119630	OTHER	TX	DPS
3	L1871	OTHER	TX	TX LICENSE

General Provider Information

NPI Number	:	1275713000
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETTY CHUNG GRASTY MD PA

Provider Business Mailing Address
First Line	:	4308 FAIRWAY DR
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75010-3232
Country	:	US
Telephone Number	:	972-409-0015
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 TUSCAN
Second Line	:	SUITE 235
City	:	IRVING
State	:	TX
Zip	:	75039-3834
Country	:	US
Telephone Number	:	972-409-0015
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BETTY CHUNG GRASTY
Credential	:	MD
Telephone Number	:	972-409-0015

Provider Enumeration Date	:	11/09/2007
Last Update Date	:	03/07/2023

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