Individual
DR. DOUGLAS RANDAL BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
6621 FANNIN ST, CCC 1630.00, HOUSTON, TX 77030-2303
(832) 822-3700
(832) 825-4164
Mailing address
6621 FANNIN ST, CCC 1630.00, HOUSTON, TX 77030-2303
(832) 822-3700
(832) 825-4164
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
25782
TX
103T00000X
Psychologist
25782
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1027542-03
—
TX
Enumeration date
01/22/2007
Last updated
01/10/2023
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