Provider Demographics
NPI:1669466041
Name:WYNNE DUNCAN, GRACIA L I (MD)
Entity Type:Individual
Prefix:
First Name:GRACIA
Middle Name:L
Last Name:WYNNE DUNCAN
Suffix:I
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GRACIA
Other - Middle Name:L
Other - Last Name:DOUCET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7580 FANNIN ST
Mailing Address - Street 2:305
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-1900
Mailing Address - Country:US
Mailing Address - Phone:713-795-5565
Mailing Address - Fax:713-795-5986
Practice Address - Street 1:7580 FANNIN ST
Practice Address - Street 2:305
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1900
Practice Address - Country:US
Practice Address - Phone:713-795-5565
Practice Address - Fax:713-795-5986
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0139207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H70487Medicare UPIN
TX00202HMedicare PIN