# ROBERT A BLOOM MD PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Robert A Bloom MD
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023401510
- **Authorized official:** ROBERT A BLOOM MD (DOCTOR)
- **Authorized official phone:** (817) 338-4636

## Contact information

- **Practice address:** 416 S. HENDERSON ST., FORT WORTH, TX 76104
- **Practice address phone:** (817) 338-4636
- **Practice address fax:** (817) 335-5421
- **Mailing address:** 416 S. HENDERSON ST., FORT WORTH, TX 76104
- **Mailing address phone:** (817) 338-4636
- **Mailing address fax:** (817) 335-5421

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | — | NULL | Yes |
| 208800000X | Urology Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/09/2015
- **Last updated:** 03/31/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 184011801 | — | TX |