Provider Demographics
NPI:1215603964
Name:GRACE MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:GRACE MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:MARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-260-0937
Mailing Address - Street 1:2675 N WYATT DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-6107
Mailing Address - Country:US
Mailing Address - Phone:520-260-0937
Mailing Address - Fax:520-320-0688
Practice Address - Street 1:2675 N WYATT DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6107
Practice Address - Country:US
Practice Address - Phone:520-260-0937
Practice Address - Fax:520-320-0688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty