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General NPI Number Information
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NPI Number | 1417697756
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Entity Type | Individual
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Provider Name | HOLLY ELIZABETH GRACE MD
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Gender | Female
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Dates
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Enumeration Date | 04/01/2022
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Last Update Date | 06/21/2024
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Provider Practice Location Address
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Address Line | 2280 INWOOD RD
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City | DALLAS
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State | TX
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Zip | 75235-7321
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Country | US
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Telephone | 214-645-8525
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Fax | 203-863-3446
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Provider Business Mailing Address
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Address Line | 2280 INWOOD RD
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City | DALLAS
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State | TX
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Zip | 75235-7321
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Country | US
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Telephone | 214-645-8525
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | BP10087483
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License Number State | TX
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