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General NPI Number Information
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NPI Number | 1972676930
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Entity Type | Individual
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Provider Name | RICHARD IAN GRACER MD
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Gender | Male
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 09/26/2011
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Provider Practice Location Address
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Address Line | 5401 NORRIS CANYON RD SUITE 102
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City | SAN RAMON
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State | CA
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Zip | 94583-5406
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Country | US
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Telephone | 925-277-1100
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Fax | 925-277-1263
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Provider Business Mailing Address
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Address Line | 5401 NORRIS CANYON RD SUITE 102
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City | SAN RAMON
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State | CA
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Zip | 94583-5406
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Country | US
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Telephone | 925-277-1100
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Fax | 925-277-1263
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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 | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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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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