Provider Demographics
NPI:1669620597
Name:GRACIA WYNNE DUNCAN, M.D., P.A.
Entity type:Organization
Organization Name:GRACIA WYNNE DUNCAN, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPANY OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WYNNE-DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-795-5565
Mailing Address - Street 1:7580 FANNIN ST
Mailing Address - Street 2:SUITE 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:
Practice Address - Street 1:7580 FANNIN ST
Practice Address - Street 2:SUITE 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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0139207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00202HMedicare PIN
TXH70487Medicare UPIN