Organization
JOHN W GRACE MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN WILLARD GRACE III M.D. (PRESIDENT)
(352) 795-2246
Entity
Organization
Contact information
Practice address
6226 W CORPORATE OAKS DR, CRYSTAL RIVER, FL 34429-8723
(352) 795-2246
Mailing address
6226 W CORPORATE OAKS DR, CRYSTAL RIVER, FL 34429-8723
(352) 795-2246
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
ME85580
FL
Other
Enumeration date
09/29/2007
Last updated
09/30/2011
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