Provider Demographics
NPI:1508249731
Name:DEGRACE, DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:DEGRACE
Suffix:
Gender:M
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:BQWFHT 80 CATHERINE ST
Mailing Address - Street 2:
Mailing Address - City:QUINTE WEST
Mailing Address - State:ON
Mailing Address - Zip Code:K8V 6N8
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BQWFHT 80 CATHERINE ST
Practice Address - Street 2:
Practice Address - City:QUINTE WEST
Practice Address - State:ON
Practice Address - Zip Code:K8V 6N8
Practice Address - Country:CA
Practice Address - Phone:613-394-0770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301108029207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine