Healthcare Provider Details

I. General information

NPI: 1790718526
Provider Name (Legal Business Name): ANN GRACE, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6909 S HOLLY CIR STE 100
CENTENNIAL CO
80112-6300
US

IV. Provider business mailing address

6909 S HOLLY CIR STE 100
CENTENNIAL CO
80112-6300
US

V. Phone/Fax

Practice location:
  • Phone: 720-528-3559
  • Fax: 720-528-9903
Mailing address:
  • Phone: 720-528-3559
  • Fax: 720-528-9903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD JAY DREXELIUS
Title or Position: VICE PRESIDENT
Credential: MD
Phone: 303-740-8630