Provider Demographics
NPI:1336207547
Name:BLOOME, ROBERT STEVEN (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:STEVEN
Last Name:BLOOME
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4707
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-0030
Mailing Address - Country:US
Mailing Address - Phone:863-293-1121
Mailing Address - Fax:863-292-4647
Practice Address - Street 1:200 AVENUE F NE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4131
Practice Address - Country:US
Practice Address - Phone:863-293-1121
Practice Address - Fax:863-292-4647
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10772208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009939919Medicaid
AL51001927OtherBLUE CROSS BLUE SHIELD
AL051556527Medicare ID - Type Unspecified
AL009939919Medicaid