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General NPI Number Information
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NPI Number | 1043651664
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Entity Type | Organization
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Legal Business Name | PETER F BLOMGREN MD PLLC
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Dates
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Enumeration Date | 07/11/2013
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Last Update Date | 07/11/2013
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Provider Practice Location Address
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Address Line | 317 W WENDOVER AVE
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City | GREENSBORO
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State | NC
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Zip | 27408-8401
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Country | US
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Telephone | 336-553-0045
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Fax |
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Provider Business Mailing Address
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Address Line | 317 W WENDOVER AVE
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City | GREENSBORO
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State | NC
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Zip | 27408-8401
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Country | US
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Telephone | 336-553-0045
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PETER F BLOMGREN
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Credential | M.D.
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Telephone | 336-553-0045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 21535
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License Number State | NC
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