Provider Demographics
NPI:1609945278
Name:KHOURI, GRACE VICTOR (MD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:VICTOR
Last Name:KHOURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5470 W. LOVERS LANE
Mailing Address - Street 2:#330
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209-0125
Mailing Address - Country:US
Mailing Address - Phone:214-956-7337
Mailing Address - Fax:469-364-8724
Practice Address - Street 1:5470 W. LOVERS LANE
Practice Address - Street 2:#330
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209
Practice Address - Country:US
Practice Address - Phone:214-956-7337
Practice Address - Fax:469-364-8724
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2241208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182489801Medicaid