Healthcare Provider Details

I. General information

NPI: 1982685004
Provider Name (Legal Business Name): JAMES DOMINIC GRADY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 EMMONS RD
CRESTED BUTTE CO
81225-5192
US

IV. Provider business mailing address

35 EMMONS RD
CRESTED BUTTE CO
81225-5192
US

V. Phone/Fax

Practice location:
  • Phone: 970-975-0866
  • Fax: 800-886-1973
Mailing address:
  • Phone: 970-975-0866
  • Fax: 800-886-1973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberCDRH0074656
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-9766
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22052
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: