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General NPI Number Information
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NPI Number | 1275859399
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Entity Type | Individual
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Provider Name | DANIEL GRADIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/14/2010
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Last Update Date | 07/12/2019
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Provider Practice Location Address
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Address Line | 600 TRIANGLE CTR SUITE 400
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City | LONGVIEW
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State | WA
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Zip | 98632-4667
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Country | US
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Telephone | 360-423-0220
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Fax | 360-423-0697
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Provider Business Mailing Address
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Address Line | 600 TRIANGLE CTR SUITE 400
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City | LONGVIEW
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State | WA
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Zip | 98632-4667
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Country | US
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Telephone | 360-423-0220
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Fax | 360-423-0697
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD60151712
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 32843-020
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD150509
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License Number State | OR
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