Healthcare Provider Details

I. General information

NPI: 1871932921
Provider Name (Legal Business Name): ASHLEY ELIZABETH BLOOM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6265 ROCK CHALK DR, SUITE 1100
LAWRENCE KS
66049-5240
US

IV. Provider business mailing address

325 MAINE STREET MSO LIBRARY
LAWRENCE KS
66044
US

V. Phone/Fax

Practice location:
  • Phone: 785-505-5070
  • Fax: 785-505-5264
Mailing address:
  • Phone: 785-505-2988
  • Fax: 785-505-5228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0439273
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: