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General NPI Number Information
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NPI Number | 1417077272
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Entity Type | Individual
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Provider Name | RICHARD B BLOOM DO
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Gender | Male
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3730 N RIDGE RD STE 200 KANSAS ENDOVASCULAR MEDICINE ASSOCIATES
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City | WICHITA
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State | KS
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Zip | 67205-1228
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Country | US
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Telephone | 316-462-1070
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Fax | 316-462-1078
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Provider Business Mailing Address
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Address Line | 95068 SPRING TIDE LN
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-5460
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Country | US
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Telephone | 904-277-2803
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Fax | 904-277-2803
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | T01157
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License Number State | KS
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