Provider Demographics
NPI:1962625087
Name:BLOMQUIST, GREGORY (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:BLOMQUIST
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 1:5040 SAIL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7533
Mailing Address - Country:US
Mailing Address - Phone:972-608-0060
Mailing Address - Fax:
Practice Address - Street 1:2401 PRESTON RD
Practice Address - Street 2:SUITE D
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-2322
Practice Address - Country:US
Practice Address - Phone:972-384-4600
Practice Address - Fax:972-384-6404
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5544207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine