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Individual
DAVID MARK GRACE
Active
Individual
DAVID MARK GRACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
01249
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
431710600
—
MD
01
—
480030745
MEDICARE RAILROAD
MD
01
—
54664503
BLUE CROSS
MD
01
—
6359 0001
BLUE CHOICE
MD
Enumeration date
03/16/2006
Last updated
11/28/2018
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