Healthcare Provider Details

I. General information

NPI: 1982282711
Provider Name (Legal Business Name): SYLVIA M BLOMSTRAND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2865 DAGGETT AVE
KLAMATH FALLS OR
97601-1106
US

IV. Provider business mailing address

PO BOX 2120
PORTLAND OR
97208-2120
US

V. Phone/Fax

Practice location:
  • Phone: 541-274-6110
  • Fax: 541-274-6106
Mailing address:
  • Phone: 541-274-6221
  • Fax: 541-274-6247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD216745
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: