Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | ME0051152 | FL |
NPI | 1104874759 |
---|---|
Provider Name | David Isaac Bloom |
First Address | Delray Beach, FL 33484-8112 |
Second Address | Delray Beach, FL 33484-8112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 21/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D61299 | (02) | FL |