Individual
CHARLES STEPHEN BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1371 HARMON AVE, WINTER PARK, FL 32789-5512
(321) 794-4747
(407) 740-5251
Mailing address
1371 HARMON AVE, WINTER PARK, FL 32789-5512
(321) 794-4747
(321) 794-4747
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
40849
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008921300
—
FL
Enumeration date
02/05/2007
Last updated
10/02/2013
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