Healthcare Provider Details

I. General information

NPI: 1952375362
Provider Name (Legal Business Name): ROBERT JOSEPH BLOOMBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 03/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 S MCCLINTOCK DR SUITE 201
TEMPE AZ
85283-3392
US

IV. Provider business mailing address

6301 S MCCLINTOCK DR SUITE 201
TEMPE AZ
85283-3392
US

V. Phone/Fax

Practice location:
  • Phone: 480-838-3100
  • Fax: 480-838-3902
Mailing address:
  • Phone: 480-838-3100
  • Fax: 480-838-3902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11959
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: