Provider Demographics
NPI:1457447898
Name:GRACER, ERIK MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:MICHAEL
Last Name:GRACER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11030 BOLLINGER CANYON RD
Mailing Address - Street 2:STE 200
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-4874
Mailing Address - Country:US
Mailing Address - Phone:925-362-1001
Mailing Address - Fax:925-855-7020
Practice Address - Street 1:11030 BOLLINGER CANYON RD
Practice Address - Street 2:STE 200
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94582-4874
Practice Address - Country:US
Practice Address - Phone:925-362-1001
Practice Address - Fax:925-855-7020
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67244207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01504ZMedicare ID - Type UnspecifiedGROUP MEDICARE ID NUMBER