Organization
MEDICAL FIREFIGHTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRACE HERCL D.O. (PHYSICIAN)
(509) 420-5125
Entity
Organization
Contact information
Practice address
CORNER OF N12 & N7, FD 2371 RED ROCK CIRCLE, FORT DEFIANCE, AZ 86504
(509) 420-5125
(614) 861-5537
Mailing address
PO BOX 2331, FORT DEFIANCE, AZ 86504-2331
(509) 420-5125
(614) 861-5537
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
OP 60046454
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OP 60046454
WA LIC
WA
Enumeration date
02/05/2013
Last updated
11/23/2016
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