Provider Demographics
NPI:1518288406
Name:BLOM, MELISSA BRAUNER (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:BRAUNER
Last Name:BLOM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14171 METROPOLIS AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4335
Mailing Address - Country:US
Mailing Address - Phone:239-320-8140
Mailing Address - Fax:239-320-8141
Practice Address - Street 1:14171 METROPOLIS AVE STE 101
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4335
Practice Address - Country:US
Practice Address - Phone:239-320-8140
Practice Address - Fax:239-320-8141
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND14007207RR0500X
FLME148100207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology