Individual
DR. CHARLES BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1800 W CHARLESTON BLVD, UNIVERSITY MEDICAL CENTER, LAS VEGAS, NV 89102-2329
(702) 383-1958
Mailing address
2716 MONA LISA ST, HENDERSON, NV 89044-0318
(702) 837-9195
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
1111
NV
207P00000X
Emergency Medicine Physician
510104304
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114835231
—
MI
01
—
CB014304
BC/BS
MI
Enumeration date
06/12/2006
Last updated
02/20/2009
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