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General NPI Number Information
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NPI Number | 1003865072
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Entity Type | Organization
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Legal Business Name | LONGVIEW ORTHOPEDIC ASSOCIATES, PLLC
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 625 - 9TH AVE. STE. 210
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City | LONGVIEW
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State | WA
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Zip | 98632-2465
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Country | US
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Telephone | 360-501-3400
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Fax | 360-423-6862
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Provider Business Mailing Address
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Address Line | 625 - 9TH AVE. STE. 210
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City | LONGVIEW
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State | WA
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Zip | 98632-2465
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Country | US
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Telephone | 360-501-3400
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Fax | 360-423-6862
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Authorized Official
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Title or Position | OWNER PARTNER
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Name | BRUCE GRAGG BLACKSTONE
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Credential | MD
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Telephone | 360-501-3400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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