Individual
BLAKE GORNOWICZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1700 E 19TH STREET, THE DALLES, OR 97058
(541) 296-1111
Mailing address
3448 CHIPPEWA CT, WEST LINN, OR 97068
(573) 424-6436
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2004018445
MO
Other
Enumeration date
09/06/2006
Last updated
12/11/2013
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