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General NPI Number Information
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NPI Number | 1952340788
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Entity Type | Organization
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Legal Business Name | WILLIAM A BLOOM MD LLC
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 105 MEDICAL CENTER DRIVE SUITE 305
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City | SLIDELL
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State | LA
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Zip | 70461-5539
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Country | US
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Telephone | 985-643-8561
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Fax | 985-649-7573
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Provider Business Mailing Address
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Address Line | 654 MARILYN DRIVE
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City | MANDEVILLE
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State | LA
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Zip | 70448-4730
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Country | US
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Telephone | 985-626-4108
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Fax | 985-649-7573
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Authorized Official
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Title or Position | MANAGER MEMBER
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Name | WILLIAM A BLOOM
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Credential | MD
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Telephone | 985-643-8561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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