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Individual

DR. WILLIAM RUSSELL GRACE

Active
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Individual

DR. WILLIAM RUSSELL GRACE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
108472
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
—
133086258
TAX ID #
NY
01
—
1578565610
NPI
NY
01
—
311391
MEDICARE PROVIDER ID
NY
01
—
NS3327
OXFORD ID
NY
Enumeration date
06/01/2005
Last updated
04/25/2017
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