NPI 1003057118

Grayson W Blomberg, PAC

Practitioner Surgical Physician Assistant Plymouth, MN

Practice location

Address: 15700 37th Ave N STE 150, Plymouth, MN 55446-3675
Phone: (651) 968-5201
Mailing address: 710 Commerce Dr STE 200, Woodbury, MN 55125-4925

Registered specialties

Surgical Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363AS0400X Licence 10560 (MN)

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Registry record

NPI: 1003057118
Entity type: Individual
Sex (as registered): Male
NPI issued: 19 Mar 2009
Record last updated: 21 Jul 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.