Walter Dietrich Gracia, M.D., P.a.

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

Legal business name

WALTER DIETRICH GRACIA, M.D., P.A.

Practice address

1204 5TH Ave
Fort Worth, TX 76104-4303

Phone

(817) 336-9450

Fax

(817) 336-3306

NPI assigned

Nov 19, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Dariela Santos

Title

Receptionist

Phone

(817) 336-9450

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Walter Dietrich Gracia, M.D.

  • Specialist
  • Fort Worth, TX
  • NPI 1245207141
  Medicare reassignment NPD
• Monica Rene Gracia, RN

  • Registered Nurse
  • Fort Worth, TX
  • NPI 1457473233
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1195430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286496000000",
    "number": "1568643500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1204 5TH AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044303",
            "telephone_number": "817-336-9450",
            "fax_number": "817-336-3306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1204 5TH AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044303",
            "telephone_number": "817-336-9450",
            "fax_number": "817-336-3306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALTER DIETRICH GRACIA, M.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-19",
        "last_updated": "2010-10-08",
        "status": "A",
        "authorized_official_last_name": "SANTOS",
        "authorized_official_first_name": "DARIELA",
        "authorized_official_title_or_position": "RECEPTIONIST",
        "authorized_official_telephone_number": "817-336-9450",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2086S0105X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery, Surgery of the Hand",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paige Elizabeth Walls, PT, DPT
• Sheena Walraven
• Walsh Chirosport PLLC
• Jordan Walsh, DC
• Ralph Claiborne Walsh Jr., DO
• Walter L Adams DC PC
• Bonnie Ahrens Walter, PA-C
• Carla Walter
• Michael Capwell Walter, M.D.
• Paige Lindsey Walter

• Plastic and Reconstructive Surgery Physician in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Plastic and Reconstructive Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.