Provider Demographics
NPI:1275713000
Name:BETTY CHUNG GRASTY MD PA
Entity Type:Organization
Organization Name:BETTY CHUNG GRASTY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:CHUNG
Authorized Official - Last Name:GRASTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-409-0015
Mailing Address - Street 1:4308 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-3232
Mailing Address - Country:US
Mailing Address - Phone:972-409-0015
Mailing Address - Fax:
Practice Address - Street 1:701 TUSCAN
Practice Address - Street 2:SUITE 235
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-3834
Practice Address - Country:US
Practice Address - Phone:972-409-0015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1871207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0059JQOtherBCBS
TXR0119630OtherDPS
TXL1871OtherTX LICENSE
BG7128083OtherDEA
TXR0119630OtherDPS
TXR0119630OtherDPS
TXH39254Medicare UPIN