MEDICARE: DR. DAVID GRACE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME42435	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110169974	OTHER	FL	RAIL ROAD MEDICARE
3	L8143	OTHER	FL	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	79789	OTHER	FL	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740275577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID GRACE MD

Provider Business Mailing Address
First Line	:	2675 WINKLER AVE FL 2
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9342
Country	:	US
Telephone Number	:	877-856-3774
Fax Number	:

Provider Business Practice Location Address
First Line	:	506 4TH AVE W
Second Line	:
City	:	PALMETTO
State	:	FL
Zip	:	34221-5203
Country	:	US
Telephone Number	:	941-933-8108
Fax Number	:	941-933-8109

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	08/25/2020

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Directions to “ DR. DAVID GRACE MD” Practice Location

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