Provider Demographics
NPI:1356664999
Name:STEPHEN G. GRACE, M.D., LTD.
Entity Type:Organization
Organization Name:STEPHEN G. GRACE, M.D., LTD.
Other - Org Name:RENO PLASTIC SURGERY, LTD.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:GRACE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-322-0515
Mailing Address - Street 1:9480 DOUBLE DIAMOND PKWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-5845
Mailing Address - Country:US
Mailing Address - Phone:775-322-0515
Mailing Address - Fax:775-322-0854
Practice Address - Street 1:9480 DOUBLE DIAMOND PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-5845
Practice Address - Country:US
Practice Address - Phone:775-322-0515
Practice Address - Fax:775-322-0854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3503208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVC96093Medicare UPIN