Healthcare Provider Details

I. General information

NPI: 1104840461
Provider Name (Legal Business Name): JOHN WALTER LACE M.D., F.C.C.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 LITTON DR STE 120
GRASS VALLEY CA
95945-5080
US

IV. Provider business mailing address

140 LITTON DR STE 120
GRASS VALLEY CA
95945-5080
US

V. Phone/Fax

Practice location:
  • Phone: 530-477-7782
  • Fax: 530-477-7792
Mailing address:
  • Phone: 530-477-7782
  • Fax: 530-477-7792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberG085476
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: