Provider Demographics
NPI:1164408654
Name:BLOEM, JOSEPHUS TH (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPHUS
Middle Name:TH
Last Name:BLOEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 ZEBULON RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804
Mailing Address - Country:US
Mailing Address - Phone:252-937-2663
Mailing Address - Fax:252-937-4894
Practice Address - Street 1:3101 ZEBULON RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804
Practice Address - Country:US
Practice Address - Phone:252-937-2663
Practice Address - Fax:252-937-4894
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24225207X00000X
NC24225NC207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7916305Medicaid
NC890230WMedicaid
1200040001Medicare NSC
NC202577CMedicare PIN
C49462Medicare UPIN