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Individual
GRANT SCOTT BLUDORN
Active
Individual
GRANT SCOTT BLUDORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
81388-21
WI
207Q00000X
Family Medicine Physician
OP61177677
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2193658
—
WA
Enumeration date
04/30/2018
Last updated
01/09/2025
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