Provider Demographics
NPI:1417618943
Name:BLOOM, ANDREA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:BLOOM
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Gender:F
Credentials:PHYSICIAN ASSISTANT
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Other - First Name:
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Mailing Address - Street 1:18511 HIGHLANDER MEDICS STREET
Mailing Address - Street 2:WBAMC
Mailing Address - City:FT BLISS
Mailing Address - State:TX
Mailing Address - Zip Code:79918
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18511 HIGHLANDER MEDICS STREET
Practice Address - Street 2:WBAMC
Practice Address - City:FT BLISS
Practice Address - State:TX
Practice Address - Zip Code:79918
Practice Address - Country:US
Practice Address - Phone:915-569-3213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant