Provider Demographics
NPI:1982658225
Name:BLOOMSTON, PAUL MARK (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MARK
Last Name:BLOOMSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-7400
Mailing Address - Fax:239-468-7942
Practice Address - Street 1:8925 COLONIAL CENTER DR STE 1000
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-7813
Practice Address - Country:US
Practice Address - Phone:239-343-7400
Practice Address - Fax:239-468-7942
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1250242086X0206X
OH350842712086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7438862OtherAETNA
FLQMP000005121963OtherMOLINA
FLP971025OtherOPTIMUM
FL7073160OtherCIGNA
FL151EVOtherBCBS
FL015646100Medicaid
FL1191282OtherWELLCARE
FL385460OtherAVMED
FLP01547650OtherRR MEDICARE
FLP1032667OtherFREEDOM
OH2659814Medicaid
FLP1032667OtherFREEDOM
FL151EVOtherBCBS