Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 188614-1205 | UT |
NPI | 1134208705 |
---|---|
Provider Name | Dr. Ronald S. Bloom |
First Address | Salt Lake City, UT 84158-1289 |
Second Address | Salt Lake City, UT 84132-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 01/08/2007 |