Most Relevant Information
Provider Data
| NPI Number: | 1003057118 |
| Provider Name: | GRAYSON W BLOMBERG PA-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363AS0400X |
| Specialty: | Physician Assistant |
| License Number: | 10560 |
Most Important Dates
| Enumeration Date: | 03/19/2009 |
| Last Updated: | 07/21/2022 |
Provider Practice Location
15700 37TH AVE N STE 150
PLYMOUTH
MN
554463675
Practice Location Phone/Fax
| Phone: | 6519685201 |
| Fax: |
Provider Mailing Location
710 COMMERCE DR STE 200
WOODBURY
MN
551254925
Provider Mailing Phone/Fax
| Phone: | 6519685201 |
| Fax: |