Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | K19765 | KS |
NPI | 1043274566 |
---|---|
Provider Name | Dr. Barry Theil Bloom |
First Address | Wichita, KS 67214-4910 |
Second Address | Wichita, KS 67214-4910 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 08/07/2007 |