Provider Demographics
NPI:1083025423
Name:BLOOM, ROSEMARY (PA)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:BLOOM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1040
Mailing Address - Street 2:
Mailing Address - City:GLOBE
Mailing Address - State:AZ
Mailing Address - Zip Code:85502-1040
Mailing Address - Country:US
Mailing Address - Phone:928-425-7133
Mailing Address - Fax:928-425-7134
Practice Address - Street 1:6116 E ARBOR AVE
Practice Address - Street 2:STE 102
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-6107
Practice Address - Country:US
Practice Address - Phone:480-654-2312
Practice Address - Fax:480-830-8506
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical