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1972676930 NPI number — RICHARD IAN GRACER MD

NPI Number: 1972676930
Health Care Provider/Practitioner: RICHARD IAN GRACER MD

Information about “1972676930” NPI (RICHARD IAN GRACER MD) exists in 1972676930 in HTML format HTML  |  1972676930 in plain Text format TXT  |  1972676930 in PDF (Portable Document Format) PDF  |  1972676930 in an XML format XML  formats.

NPI Number : 1972676930 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1972676930",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GRACER",
    "FirstName": "RICHARD",
    "MiddleName": "IAN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5401 NORRIS CANYON RD",
    "SecondLineMailingAddress": "SUITE 102",
    "MailingAddressCityName": "SAN RAMON",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "94583-5406",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "925-277-1100",
    "MailingAddressFaxNumber": "925-277-1263",
    "FirstLinePracticeLocationAddress": "5401 NORRIS CANYON RD",
    "SecondLinePracticeLocationAddress": "SUITE 102",
    "PracticeLocationAddressCityName": "SAN RAMON",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "94583-5406",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "925-277-1100",
    "PracticeLocationAddressFaxNumber": "925-277-1263",
    "EnumerationDate": "11/16/2006",
    "LastUpdateDate": "09/26/2011",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207QA0401X",
          "TaxonomyName": "Addiction Medicine (Family Medicine) Physician",
          "LicenseNumber": "G35367",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207QA0505X",
          "TaxonomyName": "Adult Medicine Physician",
          "LicenseNumber": "G35367",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "208VP0014X",
          "TaxonomyName": "Interventional Pain Medicine Physician",
          "LicenseNumber": "G35367",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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