Provider Demographics
NPI:1609841758
Name:GRACE, STEPHEN G (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:G
Last Name:GRACE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:9480 DOUBLE DIAMOND PKWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-5845
Mailing Address - Country:US
Mailing Address - Phone:775-322-0515
Mailing Address - Fax:775-322-0854
Practice Address - Street 1:9480 DOUBLE DIAMOND PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-5845
Practice Address - Country:US
Practice Address - Phone:775-322-0515
Practice Address - Fax:775-322-0854
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2010-07-22
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Provider Licenses
StateLicense IDTaxonomies
NV3503208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C96093Medicare UPIN
35135Medicare ID - Type Unspecified