Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MD00042152 | WA |
N | 207YP0228X | Pediatric Otolaryngology | MD00042152 | WA |
NPI | 1215996038 |
---|---|
Provider Name | Mr. David Charles Bloom |
First Address | Vancouver, WA 98686 |
Second Address | Vancouver, WA 98686 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 02/05/2018 |