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General NPI Number Information
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NPI Number | 1275713000
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Entity Type | Organization
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Legal Business Name | BETTY CHUNG GRASTY MD PA
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Dates
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Enumeration Date | 11/09/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 701 TUSCAN SUITE 235
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City | IRVING
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State | TX
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Zip | 75039-3834
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Country | US
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Telephone | 972-409-0015
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Fax |
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Provider Business Mailing Address
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Address Line | 4308 FAIRWAY DR
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City | CARROLLTON
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State | TX
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Zip | 75010-3232
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Country | US
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Telephone | 972-409-0015
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BETTY CHUNG GRASTY
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Credential | MD
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Telephone | 972-409-0015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | L1871
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License Number State | TX
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