Provider Demographics
NPI:1043316227
Name:FREIRE, GRACE A (MD)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:A
Last Name:FREIRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 FIFTH STREET SOUTH
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4804
Mailing Address - Country:US
Mailing Address - Phone:727-767-3333
Mailing Address - Fax:727-767-8990
Practice Address - Street 1:601 5TH ST S
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4804
Practice Address - Country:US
Practice Address - Phone:727-767-3333
Practice Address - Fax:727-767-8990
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1088202080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003016500Medicaid
FLME108820OtherFLORIDA MEDICAL LICENSE