Provider Demographics
NPI:1407853674
Name:GRASTY, BETTY CHUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:BETTY
Middle Name:CHUNG
Last Name:GRASTY
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:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7208
Mailing Address - Country:US
Mailing Address - Phone:214-964-0600
Mailing Address - Fax:214-964-0638
Practice Address - Street 1:6121 N HIGHWAY 161 STE 300
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-2270
Practice Address - Country:US
Practice Address - Phone:469-647-4004
Practice Address - Fax:469-647-4037
Is Sole Proprietor?:No
Enumeration Date:2005-07-04
Last Update Date:2022-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1871207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1443186-02Medicaid
TXL1871OtherMEDICAL LICENSE NUMBER
TX7628230OtherAETNA PROVIDER NUMBER
BG7128083OtherDEA
TX1443186-02Medicaid
TXL1871OtherMEDICAL LICENSE NUMBER
110246912OtherRAILROAD MEDICARE NUMBER
431989415OtherSOLO PRACTICE TAX ID NUMB
TX8H2080OtherBCBS TX PROVIDER NUMBER