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Organization
JEFFREY BLOOM D.O. INC, DBA BACK BAY MEDICAL
Active
Organization
JEFFREY BLOOM D.O. INC, DBA BACK BAY MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY HOWARD BLOOM D.O. (OWNER)
(949) 263-1242
Entity
Organization
Contact information
Practice address
20311 SW ACACIA ST, #100, NEWPORT BEACH, CA 92660-1733
(949) 263-1242
(949) 263-1280
Mailing address
20311 SW ACACIA ST, #100, NEWPORT BEACH, CA 92660-1733
(949) 263-1242
(949) 263-1280
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
20A6397
CA
Other
Enumeration date
12/27/2012
Last updated
12/27/2012
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