Provider Demographics
NPI:1497932321
Name:RICHARD I. GRACER, MD, INC.
Entity Type:Organization
Organization Name:RICHARD I. GRACER, MD, INC.
Other - Org Name:GRACER BEHAVIORAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:IAN
Authorized Official - Last Name:GRACER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-366-4860
Mailing Address - Street 1:4 CROW CANYON CT
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583
Mailing Address - Country:US
Mailing Address - Phone:925-366-4860
Mailing Address - Fax:925-886-4466
Practice Address - Street 1:4 CROW CANYON CT
Practice Address - Street 2:SUITE 210
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583
Practice Address - Country:US
Practice Address - Phone:925-366-4860
Practice Address - Fax:925-886-4466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG35367101YA0400X, 207QA0505X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ07604ZOtherBLUE SHIELD PIN
CACN5516Medicare PIN
CAZZZ07604ZOtherBLUE SHIELD PIN