Provider Demographics
NPI:1790718526
Name:ANN GRACE, M.D., P.C.
Entity Type:Organization
Organization Name:ANN GRACE, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:DREXELIUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-740-8630
Mailing Address - Street 1:6909 S HOLLY CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-6300
Mailing Address - Country:US
Mailing Address - Phone:720-528-3559
Mailing Address - Fax:720-528-9903
Practice Address - Street 1:6909 S HOLLY CIR STE 100
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-6300
Practice Address - Country:US
Practice Address - Phone:720-528-3559
Practice Address - Fax:720-528-9903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
432008Medicare ID - Type Unspecified