Healthcare Provider Details

I. General information

NPI: 1780947937
Provider Name (Legal Business Name): GURJEET SINGH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 DELAWARE ST
LONGVIEW WA
98632-2367
US

IV. Provider business mailing address

PO BOX 2077
PORTLAND OR
97208-2077
US

V. Phone/Fax

Practice location:
  • Phone: 360-414-2730
  • Fax: 360-414-2739
Mailing address:
  • Phone: 503-415-5982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number13524
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD60720449
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMC-1674
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: