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General NPI Number Information
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NPI Number | 1831273259
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Entity Type | Organization
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Legal Business Name | RICHARD R. BLOOM M.D. LLC
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 04/03/2008
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Provider Practice Location Address
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Address Line | 1900 5TH AVE
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City | COLUMBUS
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State | GA
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Zip | 31904-8916
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Country | US
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Telephone | 706-576-4474
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Fax | 706-576-5940
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Provider Business Mailing Address
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Address Line | PO BOX 7811
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City | COLUMBUS
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State | GA
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Zip | 31908-7811
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Country | US
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Telephone | 706-576-4474
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Fax | 706-576-5940
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Authorized Official
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Title or Position | CEO
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Name | DR. RICHARD RICHARDO BLOOM
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Credential | M.D.
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Telephone | 706-576-4474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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