Individual
DR. ELEANOR GRACE BLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D., M.P.H.
Contact information
Practice address
23320 HIGHWAY 99, EDMONDS, WA 98026-8744
(425) 640-5500
(425) 640-5520
Mailing address
23320 HIGHWAY 99, EDMONDS, WA 98026-8744
(425) 640-5500
(425) 640-5520
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD60233140
WA
207Q00000X
Family Medicine Physician
ML60095637
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2020182
—
WA
01
—
G8923057
MEDICARE PTAN
WA
01
—
MD60233140
PHYSICIAN AND SURGEON LICENSE
WA
Enumeration date
04/16/2009
Last updated
03/07/2023
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