Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 30280 | AZ |
NPI | 1003886292 |
---|---|
Provider Name | Joshua Aaron Bloomstone |
First Address | Phoenix, AZ 85012-1351 |
Second Address | Phoenix, AZ 85012-1351 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 04/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
050090678 | MEDICARE RAILROAD (01) | |
740532 | (05) | AZ |
G56280 | (02) |