Provider Demographics
NPI:1104874759
Name:BLOOM, DAVID ISAAC (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ISAAC
Last Name:BLOOM
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 1:5350 W ATLANTIC AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-8112
Mailing Address - Country:US
Mailing Address - Phone:561-496-5677
Mailing Address - Fax:561-496-5824
Practice Address - Street 1:5350 W ATLANTIC AVE
Practice Address - Street 2:STE 100
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-8112
Practice Address - Country:US
Practice Address - Phone:561-496-5677
Practice Address - Fax:561-496-5824
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0051152207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL05843ZMedicare ID - Type Unspecified
FLD61299Medicare UPIN