Healthcare Provider Details

I. General information

NPI: 1174998918
Provider Name (Legal Business Name): JEFFREY GRACE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2015
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

U.S. ARMY HEALTH CLINIC STUTTGART UNIT 30401
APO AE
09154-0401
US

IV. Provider business mailing address

U.S. ARMY HEALTH CLINIC STUTTGART UNIT 30401
APO AE
09154-0401
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-2491
  • Fax:
Mailing address:
  • Phone: 314-590-2491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: