Gracia, Walter Dietrich
Gracia, Walter Dietrich is an individual health care provider with primary practice located at 1204 5Th Ave , Fort Worth TX 76104-4303. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Gracia, Walter Dietrich can be contacted via phone (817) 336-9450.Contact Information
Primary practice address
1204 5Th Ave
Fort Worth TX 76104-4303
Phone: (817) 336-9450
Fax: (817) 336-3306
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | G5103 | Texas |
Profile Details
| NPI number | 1245207141 |
|---|---|
| LBN Legal business name | Gracia, Walter Dietrich |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 1st, 2006 |
| Last updated | Aug 4th, 2014 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1245207141 | NPPES |
| Texas | Other | F97N | BLUE CROSS BLUE SHIELD |
| Texas | MEDICAID | 126310502 | BLUE CROSS BLUE SHIELD |
| Texas | Other | 240002368 | BLUE CROSS BLUE SHIELD |
| Texas | Other | 4273318 | BLUE CROSS BLUE SHIELD |
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