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General NPI Number Information
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NPI Number | 1003495268
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Entity Type | Individual
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Provider Name | GEORGE BARNES BLOOM II MD
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Gender | Male
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Dates
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Enumeration Date | 04/05/2021
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 101 HOSPITAL DR
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City | MAGNOLIA
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State | AR
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Zip | 71753-2415
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Country | US
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Telephone | 870-235-3000
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Fax | 575-235-6696
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Provider Business Mailing Address
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Address Line | 101 HOSPITAL DR
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City | MAGNOLIA
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State | AR
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Zip | 71753-2415
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Country | US
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Telephone | 870-235-3000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | E-18351
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License Number State | AR
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