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General NPI Number Information
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NPI Number | 1023213782
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Entity Type | Organization
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Legal Business Name | NORMAN A BLOOM MD PA
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Dates
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Enumeration Date | 06/20/2007
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Last Update Date | 06/22/2010
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Provider Practice Location Address
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Address Line | 1 SW 129TH AVE SUITE 109
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-1761
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Country | US
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Telephone | 305-825-8669
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Fax |
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Provider Business Mailing Address
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Address Line | 1 SW 129TH AVE SUITE 109
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-1761
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Country | US
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Telephone | 305-825-8669
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. NORMAN BLOOM
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Credential | MD
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Telephone | 305-931-6663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | ME14272
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License Number State | FL
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