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Organization
JOHANNES V. BLOM, MD, PA
Active
Organization
JOHANNES V. BLOM, MD, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GABRIELA ENGELS (ADMINISTRATOR)
(954) 964-6114
Entity
Organization
Contact information
Practice address
300 SE 17TH ST, 2ND FLOOR, FT LAUDERDALE, FL 33316-2550
(954) 964-6114
Mailing address
300 SE 17TH ST, 2ND FLOOR, FT LAUDERDALE, FL 33316-2550
(954) 964-6114
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
ME94285
FL
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
ME94285
FL
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
ME94285
FL
207XX0801X
Orthopaedic Trauma Physician
ME94285
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1184654519
PROVIDER NPI
FL
05
—
275038400
—
FL
Enumeration date
06/23/2010
Last updated
06/23/2010
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