Organization
R LAMONT BLOOM MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. R. LAMONT BLOOM MD (PRESIDENT)
(316) 265-0705
Entity
Organization
Contact information
Practice address
406 E CENTRAL AVE, WICHITA, KS 67202-1058
(316) 265-0705
(316) 265-0785
Mailing address
406 E CENTRAL AVE, WICHITA, KS 67202-1058
(316) 265-0705
(316) 265-0785
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
04-18702
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100195740A
—
KS
Enumeration date
12/01/2011
Last updated
12/01/2011
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