Provider Demographics
NPI:1326022021
Name:MORAN, GRACE Q (MD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:Q
Last Name:MORAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:QUIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1310 24TH AVE S # 114
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-2637
Mailing Address - Country:US
Mailing Address - Phone:615-873-7810
Mailing Address - Fax:615-873-8321
Practice Address - Street 1:1310 21ST AVE S # 114
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2704
Practice Address - Country:US
Practice Address - Phone:615-873-7810
Practice Address - Fax:615-873-8321
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00813172085R0202X
TN341162085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3882203Medicaid
TN3721492Medicaid
TN3721492Medicaid
TN3882203Medicaid
TN3721492Medicare ID - Type UnspecifiedRA GROUP