Individual
GRACIE DONNICE TAD MCREYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1201 W 38TH ST, AUSTIN, TX 78705-1006
(512) 324-1010
Mailing address
3405 CACTUS WREN WAY, AUSTIN, TX 78746-6636
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
L6522
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
158761001
—
TX
05
—
158761004
—
TX
05
—
158907901
—
TX
05
—
158907903
—
TX
Enumeration date
06/16/2006
Last updated
10/29/2008
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