Provider Demographics
NPI:1740288729
Name:TAMESIS, GRACE P (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:P
Last Name:TAMESIS
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16010 PARK VALLEY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-3574
Mailing Address - Country:US
Mailing Address - Phone:303-601-5399
Mailing Address - Fax:
Practice Address - Street 1:16010 PARK VALLEY DR
Practice Address - Street 2:SUITE 300
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-3574
Practice Address - Country:US
Practice Address - Phone:303-601-5399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2016-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1693207K00000X, 2080P0201X, 207KI0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
No207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO79878245Medicaid
CO79878245Medicaid