Provider Demographics
NPI:1578582854
Name:HONLES, GRACE LORENA (MD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:LORENA
Last Name:HONLES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12221 N MOPAC EXPY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2401
Mailing Address - Country:US
Mailing Address - Phone:512-334-2509
Mailing Address - Fax:512-334-2589
Practice Address - Street 1:5701 W SLAUGHTER LN BLDG C
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-6528
Practice Address - Country:US
Practice Address - Phone:512-334-2509
Practice Address - Fax:512-334-2589
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0273207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX043221302Medicaid
TX043221302Medicaid
H30344Medicare UPIN