| Doctor Name: | GRAYSON W BLOMBERG |
| NPI Number: | 1003057118 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | 10560 |
| Business Practice Address: | 303 Catlin St # Streeto Buffalo, MN - 553131947 |
| Business Phone Number: | 6519685675 |
| Business Fax Number: | 6519685904 |
| Mailing Address: | 710 Commerce Dr Ste 200, WOODBURY |
| State: | MN |
| Postal Code: | 551254925 |
| Phone Number: | 6519685675 |
| Fax Number: | 6519685904 |
| NPI Enumeration Date: | 03/19/2009 |
| NPI Last Update Date: | 12/29/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AS0400X |
| License Number: | 10560 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Surgical |
| Taxonomy Definition: | |