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General NPI Number Information
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NPI Number | 1710104484
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Entity Type | Individual
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Provider Name | GUSTAV A BLOMQUIST MD
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Gender | Male
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 3448 US ROUTE 60
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City | HUNTINGTON
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State | WV
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Zip | 25705-2906
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Country | US
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Telephone | 304-522-1550
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Fax | 304-522-1073
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Provider Business Mailing Address
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Address Line | 3448 US ROUTE 60
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City | HUNTINGTON
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State | WV
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Zip | 25705-2906
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Country | US
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Telephone | 304-522-1550
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Fax | 304-522-1073
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | M6052
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 29216
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME107556
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 63634
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 20968
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License Number State | MS
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Taxonomy #6
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 2010-00231
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License Number State | NC
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Taxonomy #7
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 32233.MD
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License Number State | SC
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Taxonomy #8
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD0000045451
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License Number State | TN
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Taxonomy #9
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 43773
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License Number State | KY
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Taxonomy #10
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 35.152015
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License Number State | OH
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Taxonomy #11
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 3441
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License Number State | WV
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