Provider Demographics
NPI:1003278474
Name:GRACE P TAMESIS MD PA
Entity Type:Organization
Organization Name:GRACE P TAMESIS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:P
Authorized Official - Last Name:TAMESIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD MPH
Authorized Official - Phone:303-601-5399
Mailing Address - Street 1:16010 PARK VALLEY DR STE 300
Mailing Address - Street 2:GRACE P. TAMESIS MD PA
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-3577
Mailing Address - Country:US
Mailing Address - Phone:737-203-9645
Mailing Address - Fax:737-203-9646
Practice Address - Street 1:16010 PARK VALLEY DR STE 300
Practice Address - Street 2:GRACE P. TAMESIS MD PA
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-3577
Practice Address - Country:US
Practice Address - Phone:737-203-9645
Practice Address - Fax:737-203-9646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1693261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK1693OtherLICENSE