MEDICARE: MARTIN GLENN BLOOM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	ME27887	FL

General Provider Information

NPI Number	:	1487760732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIN GLENN BLOOM MD

Provider Business Mailing Address
First Line	:	3100 S FEDERAL HWY
Second Line	:	SUITE J
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-3222
Country	:	US
Telephone Number	:	561-257-2511
Fax Number	:	561-257-5051

Provider Business Practice Location Address
First Line	:	3100 S FEDERAL HWY
Second Line	:	SUITE J
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-3222
Country	:	US
Telephone Number	:	561-257-2511
Fax Number	:	561-257-5051

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	01/16/2015

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