Bruce Gragg Blackstone, MD | |
625 9th Ave, Suite 210, Longview, WA 98632-2465 | |
(360) 501-3400 | |
(360) 423-6862 |
Full Name | Bruce Gragg Blackstone |
---|---|
Gender | Male |
Speciality | Orthopaedic Surgery |
Location | 625 9th Ave, Longview, Washington |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1891760211 | NPI | - | NPPES |
1131101 | Medicaid | WA | |
195560 | Medicaid | OR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207X00000X | Orthopaedic Surgery | MD00020762 (Washington) | Primary |
Entity Name | Kaiser Foundation Health Plan Of The Northwest |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1184786527 PECOS PAC ID: 5799688230 Enrollment ID: O20040220000099 |
Mailing Address | Practice Location Address |
---|---|
Bruce Gragg Blackstone, MD 625 9th Ave, Suite 210, Longview, WA 98632-2465 Ph: (360) 501-3400 | Bruce Gragg Blackstone, MD 625 9th Ave, Suite 210, Longview, WA 98632-2465 Ph: (360) 501-3400 |
Dr. Tony C Lin, M.D. Orthopedic Surgery Medicare: Accepting Medicare Assignments Practice Location: 625 9th Ave, Ste 210, Longview, WA 98632 Phone: 360-501-3400 Fax: 360-423-5682 | |
William Taylor Turner, M.D. Orthopedic Surgery Medicare: Accepting Medicare Assignments Practice Location: 625 9th Ave, Ste 210, Longview, WA 98632 Phone: 360-501-3400 Fax: 360-423-6862 | |
Dr. Peter Kung, M.D. Orthopedic Surgery Medicare: Accepting Medicare Assignments Practice Location: 625 9th Ave Ste 210, Longview, WA 98632 Phone: 360-501-3400 Fax: 360-423-6862 | |
David Michael Black, MD Orthopedic Surgery Medicare: Not Enrolled in Medicare Practice Location: 625 9th Ave, Ste 210, Longview, WA 98632 Phone: 360-501-3400 Fax: 360-423-6862 | |
Anthony J Lauder, MD Orthopedic Surgery Medicare: Accepting Medicare Assignments Practice Location: 625 9th Ave Ste 210, Longview, WA 98632 Phone: 360-501-3400 Fax: 360-423-6862 | |
Jon Edward Kretzler, M.D. Orthopedic Surgery Medicare: Accepting Medicare Assignments Practice Location: 625 9th Ave, Ste 210, Longview, WA 98632 Phone: 360-501-3400 Fax: 360-423-6862 |