Physician Compare National (NPI:1336293091)

HEALTHCARE PROVIDER: CHARLES R BLOOMER D.D.S.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1336293091
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4688856610
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110311000073
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BLOOMER
	Individual professional last name
Provider First Name	CHARLES
	Individual professional first name
Provider Middle Name	RICHARD
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	THE DENTAL SCHOOL AT UNIVERSITY OF TEXAS HSC AT SAN ANTONIO
	Individual professional's medical school
Graduation Year	1980
	Individual professional's medical school graduation year
Primary Specialty	ORAL SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	5200 BUFFALO GAP RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE B
	Group Practice or individual's line 2 address
City	ABILENE
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	796064151
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3256911140
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y