Healthcare Provider Details

I. General information

NPI: 1184714768
Provider Name (Legal Business Name): TODD GRAZIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 WORTH ST. SUITE 250
DALLAS TX
75246
US

IV. Provider business mailing address

3410 WORTH ST. SUITE 250
DALLAS TX
75246
US

V. Phone/Fax

Practice location:
  • Phone: 214-820-6856
  • Fax: 214-820-1474
Mailing address:
  • Phone: 214-820-6856
  • Fax: 214-820-1474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberR9070
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number39492
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberR9070
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: