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General NPI Number Information
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NPI Number | 1982658225
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Entity Type | Individual
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Provider Name | PAUL MARK BLOOMSTON MD
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Gender | Male
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 8925 COLONIAL CENTER DR STE 1000
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City | FORT MYERS
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State | FL
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Zip | 33905-7813
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Country | US
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Telephone | 239-343-7400
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Fax | 239-468-7942
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Provider Business Mailing Address
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Address Line | PO BOX 2147
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City | FORT MYERS
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State | FL
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Zip | 33902-2147
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Country | US
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Telephone | 239-343-7400
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Fax | 239-468-7942
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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 | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | ME125024
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | 35084271
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License Number State | OH
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