Provider Demographics
NPI:1184661415
Name:BLOOM, JOSEPH PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:PAUL
Last Name:BLOOM
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 1:2400 N COURTENAY PKWY
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-4127
Mailing Address - Country:US
Mailing Address - Phone:321-637-2871
Mailing Address - Fax:321-453-8490
Practice Address - Street 1:2400 N COURTENAY PKWY
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4127
Practice Address - Country:US
Practice Address - Phone:321-637-2871
Practice Address - Fax:321-453-8490
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65147207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25823OtherBCBS
FL375931800Medicaid
FL25823OtherBCBS
FL375931800Medicaid