MEDICARE: DR. PAUL MARK BLOOMSTON MD

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	2086X0206X	Surgical Oncology Physician	ME125024	FL
2	2086X0206X	Surgical Oncology Physician	35084271	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	P01547650	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7438862	OTHER	FL	AETNA
2	QMP000005121963	OTHER	FL	MOLINA
3	P971025	OTHER	FL	OPTIMUM
4	7073160	OTHER	FL	CIGNA
5	151EV	OTHER	FL	BCBS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	1191282	OTHER	FL	WELLCARE
8	385460	OTHER	FL	AVMED
10	P1032667	OTHER	FL	FREEDOM
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982658225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL MARK BLOOMSTON MD

Provider Business Mailing Address
First Line	:	PO BOX 2147
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-2147
Country	:	US
Telephone Number	:	239-343-7400
Fax Number	:	239-468-7942

Provider Business Practice Location Address
First Line	:	8925 COLONIAL CENTER DR STE 1000
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33905-7813
Country	:	US
Telephone Number	:	239-343-7400
Fax Number	:	239-468-7942

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

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	01/22/2025

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