Blackstone, Bruce Gragg

Blackstone, Bruce Gragg is an individual health care provider with primary practice located at 625 9Th Ave Suite 210, Longview WA 98632-2465. He recently has only one registered license in Allopathic & Osteopathic Physicians / Orthopaedic Surgery, which is considered as his primary health care specialty. Blackstone, Bruce Gragg can be contacted via phone (360) 501-3400.

Contact Information

Primary practice address
625 9Th Ave Suite 210 Longview WA 98632-2465
Phone: (360) 501-3400
Fax: (360) 423-6862
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X MD00020762 Washington

Profile Details

NPI number 1891760211
LBN Legal business name Blackstone, Bruce Gragg
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 20th, 2006
Last updated Sep 22nd, 2010 - about 14 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1891760211 NPPES
Washington MEDICAID 1131101
Washington MEDICAID 195560

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