Provider Demographics
NPI:1467523290
Name:ARCHER, GRACE EMILY (MD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:EMILY
Last Name:ARCHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:G.
Other - Middle Name:EMILY
Other - Last Name:ARCHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:M,D,
Mailing Address - Street 1:1215 S COULTER ST
Mailing Address - Street 2:STE 400
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1769
Mailing Address - Country:US
Mailing Address - Phone:806-358-8332
Mailing Address - Fax:
Practice Address - Street 1:1215 S COULTER ST
Practice Address - Street 2:STE 400
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1769
Practice Address - Country:US
Practice Address - Phone:806-358-8331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3114207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX99086301Medicaid
TX88921KMedicare ID - Type Unspecified
TX99086301Medicaid