Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | ME41170 | FL |
NPI | 1053337394 |
---|---|
Provider Name | Marc B Bloom |
First Address | Tampa, FL 33613-4656 |
Second Address | Tampa, FL 33613-4656 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
048065700 | (05) | FL |
D86022 | (02) | FL |