Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | MD24000 | OR |
NPI | 1104814201 |
---|---|
Provider Name | Heidi Taylor Bloom |
First Address | Medford, OR 97504-8343 |
Second Address | Medford, OR 97504-8343 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2005 |
Last Update Date | 20/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
286646 | (05) | OR |
H71409 | (02) |