MEDICARE: MANUEL G BLOOM JR. M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	E7566	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023029089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANUEL G BLOOM JR. M.D

Provider Business Mailing Address
First Line	:	6445 MAIN ST FL 22
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1502
Country	:	US
Telephone Number	:	713-441-7182
Fax Number	:	713-796-1701

Provider Business Practice Location Address
First Line	:	6550 FANNIN ST STE 1101
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2740
Country	:	US
Telephone Number	:	713-441-3948
Fax Number	:	713-441-1224

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	07/07/2023

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