Provider Demographics
NPI:1275859399
Name:GRADIN, DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:GRADIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 TRIANGLE CTR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-4667
Mailing Address - Country:US
Mailing Address - Phone:360-423-0220
Mailing Address - Fax:360-423-0697
Practice Address - Street 1:600 TRIANGLE CTR
Practice Address - Street 2:SUITE 400
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-4667
Practice Address - Country:US
Practice Address - Phone:360-423-0220
Practice Address - Fax:360-423-0697
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60151712207W00000X
WI32843-020207W00000X
ORMD150509207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology