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General NPI Number Information
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NPI Number | 1497932321
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Entity Type | Organization
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Legal Business Name | RICHARD I. GRACER, MD, INC.
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Dates
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Enumeration Date | 01/22/2008
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Last Update Date | 02/05/2019
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Provider Practice Location Address
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Address Line | 4 CROW CANYON CT SUITE 210
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City | SAN RAMON
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State | CA
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Zip | 94583
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Country | US
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Telephone | 925-366-4860
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Fax | 925-886-4466
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Provider Business Mailing Address
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Address Line | 4 CROW CANYON CT SUITE 210
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City | SAN RAMON
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State | CA
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Zip | 94583
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Country | US
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Telephone | 925-366-4860
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Fax | 925-886-4466
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RICHARD IAN GRACER
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Credential | MD
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Telephone | 925-366-4860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | G35367
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | G35367
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | G35367
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License Number State | CA
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