Healthcare Provider Details

I. General information

NPI: 1619055571
Provider Name (Legal Business Name): GRACIA MEDICAL, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 N RIEDEL ST
YORKTOWN TX
78164-1810
US

IV. Provider business mailing address

508 N RIEDEL ST
YORKTOWN TX
78164-1810
US

V. Phone/Fax

Practice location:
  • Phone: 361-564-3383
  • Fax: 361-564-4224
Mailing address:
  • Phone: 361-564-3383
  • Fax: 361-564-4224

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: DAVID KEEFAUVER
Title or Position: MANAGING PARTNER
Credential:
Phone: 361-275-2381