Individual
GRANT SCOTT BLUDORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1615 MAPLE LN, ASHLAND, WI 54806-3626
(715) 685-5700
Mailing address
PO BOX 34703, SEATTLE, WA 98124-1703
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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