Healthcare Provider Details

I. General information

NPI: 1548767312
Provider Name (Legal Business Name): GRACE WOODS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 PRESTON RD
PLANO TX
75024-3214
US

IV. Provider business mailing address

7601 PRESTON RD
PLANO TX
75024-3214
US

V. Phone/Fax

Practice location:
  • Phone: 214-456-9250
  • Fax: 214-456-1240
Mailing address:
  • Phone: 214-456-9250
  • Fax: 214-456-1240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberT1609
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: