Individual
BRICE WILLIAM BLATZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD, MS
Contact information
Practice address
221 MICHIGAN ST NE, GRAND RAPIDS, MI 49503-2543
(616) 391-1405
(616) 391-8611
Mailing address
9925 SW NIMBUS AVE, STE 100, BEAVERTON, OR 97008-7591
(503) 217-6305
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
4301092779
MI
390200000X
Student in an Organized Health Care Education/Training Program
LL2132
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LL2132
REG. MEDICAL LIC.
NV
Enumeration date
06/25/2008
Last updated
03/10/2021
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