Provider Demographics
NPI:1659556173
Name:GRACE OB/GYN ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:GRACE OB/GYN ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:J
Authorized Official - Last Name:YALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-231-3898
Mailing Address - Street 1:403 W CAMPBELL RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3465
Mailing Address - Country:US
Mailing Address - Phone:972-231-3898
Mailing Address - Fax:
Practice Address - Street 1:403 W CAMPBELL RD
Practice Address - Street 2:SUITE 400
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3465
Practice Address - Country:US
Practice Address - Phone:972-231-3898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9024174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG55669Medicare UPIN