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Dr. Walter Dietrich Gracia, MD
Specialist in Fort Worth, Texas
NPI 1245207141

Walter Dietrich Gracia is a Specialist based in Fort Worth, TX. Walter Dietrich Gracia practices in Fort Worth, TX and has the professional credentials of MD. The NPI Number for Walter Dietrich Gracia is 1245207141 and holds a License No. G5103 (Texas).

The current practice location address for Walter Dietrich Gracia is 1204 5Th Ave, Fort Worth, TX and can be reached out via phone at 817-336-9450 and via fax at 817-336-3306.

Location: 1204 5Th Ave, Fort Worth, TX, 76104-4303
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1245207141
Provider Name
Walter Dietrich Gracia
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
1204 5Th Ave, Fort Worth, TX, 76104-4303
Phone Number
817-336-9450
Fax Number
817-336-3306
Provider Enumeration Date
03/01/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
F97N 01 TX BLUE CROSS BLUE SHIELD
126310502 05 TX
240002368 01 TX RAILROAD MEDICARE
4273318 01 TX AETNA
institution
Provider Business Practice Location Address Details
Address
1204 5Th Ave
City
Fort Worth
State
Texas
Zip
76104-4303
Phone Number
817-336-9450
Fax Number
817-336-3306
person
Provider Business Mailing Address Details
Address
1204 5Th Ave
City
Fort Worth
State
Texas
Zip
76104-4303
Phone Number
817-336-9450
Fax Number
817-336-3306
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
G5103 (Texas)
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
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