Provider Demographics
NPI:1417120973
Name:ERIK M GRACER MD INC
Entity type:Organization
Organization Name:ERIK M GRACER MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GRACER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-362-1001
Mailing Address - Street 1:2723 CROW CANYON RD
Mailing Address - Street 2:STE 110
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1635
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2723 CROW CANYON RD
Practice Address - Street 2:STE 110
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1635
Practice Address - Country:US
Practice Address - Phone:925-362-1001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67244207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01504ZMedicare PIN
CAH54647Medicare UPIN