Provider Demographics
NPI:1225011505
Name:BLOEMKER, E. FREDRICK (MD)
Entity Type:Individual
Prefix:
First Name:E.
Middle Name:FREDRICK
Last Name:BLOEMKER
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 1:3330 N 2ND ST
Mailing Address - Street 2:STE 600
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2395
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3330 N 2ND ST
Practice Address - Street 2:SUITE #600
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2368
Practice Address - Country:US
Practice Address - Phone:602-263-9345
Practice Address - Fax:602-263-0778
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5454207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ180018692OtherRAILROAD MEDICARE
AZ225575Medicaid
AZ18WCGTH01Medicare PIN
AZC99160Medicare UPIN
AZ225575Medicaid