Provider Demographics
NPI:1750425849
Name:BLOOMQUIST, SHEILA EVA (MD)
Entity type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:EVA
Last Name:BLOOMQUIST
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 1:101 E. HIGHWAY 260
Mailing Address - Street 2:SUITE G
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541
Mailing Address - Country:US
Mailing Address - Phone:928-478-8905
Mailing Address - Fax:928-478-8915
Practice Address - Street 1:101 E STATE HIGHWAY 260
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-4921
Practice Address - Country:US
Practice Address - Phone:928-478-8905
Practice Address - Fax:928-478-8915
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036112093207Q00000X
AZ40881207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
178726OtherAHCCCS #
AZ178726Medicaid
K17261Medicare UPIN
178726OtherAHCCCS #
AZ178726Medicaid