Organization
LONGVIEW ORTHOPEDIC ASSOCIATES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE GRAGG BLACKSTONE MD (OWNER PARTNER)
(360) 501-3400
Entity
Organization
Contact information
Practice address
625 - 9TH AVE., STE. 210, LONGVIEW, WA 98632-2465
(360) 501-3400
(360) 423-6862
Mailing address
625 - 9TH AVE., STE. 210, LONGVIEW, WA 98632-2465
(360) 501-3400
(360) 423-6862
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0198037
LABOR & INDUSTRIES
WA
05
—
269896
—
OR
01
—
5445810001
CIGNA DME
WA
05
—
7127632
—
WA
01
—
DD4041
RAILROAD MEDICARE
WA
Enumeration date
05/08/2006
Last updated
03/03/2025
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