Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | MD24850 | TN |
NPI | 1003848722 |
---|---|
Provider Name | Ronald A. Gracy II |
First Address | Cincinnati, OH 45263-0001 |
Second Address | Chattanooga, TN 37412-3909 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 31/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000593568B | (05) | GA |
3036300 | BCBS OF TENNESSEE (01) | TN |
3079844 | (05) | TN |
3079849 | (05) | TN |
4150069 | BLUE CROSS (01) | TN |
E87862 | (02) | TN |
P00217707 | RAILROAD MEDICARE (01) | TN |