Provider Demographics
NPI:1275750150
Name:BLOMQUIST, GUSTAV ARTHUR JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GUSTAV
Middle Name:ARTHUR
Last Name:BLOMQUIST
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1110 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7214
Mailing Address - Country:US
Mailing Address - Phone:336-273-3536
Mailing Address - Fax:
Practice Address - Street 1:1110 SUNSET DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7214
Practice Address - Country:US
Practice Address - Phone:336-273-3536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19100207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery