# JOHANNES V. BLOM, MD, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457584468
- **Authorized official:** GABRIELA ENGELS (ADMINISTRATOR)
- **Authorized official phone:** (954) 964-6114

## Contact information

- **Practice address:** 601 N FLAMINGO RD, SUITE 101, PEMBROKE PINES, FL 33028-1015
- **Practice address phone:** (954) 964-6114
- **Practice address fax:** (954) 962-1994
- **Mailing address:** 3702 WASHINGTON ST, SUITE 202, HOLLYWOOD, FL 33021-8282
- **Mailing address phone:** (954) 964-6114
- **Mailing address fax:** (954) 962-1994

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | ME94285 | FL | Yes |

## Other

- **Enumeration date:** 08/25/2009
- **Last updated:** 08/25/2009