Individual
JOSEPH DAVID BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-6176
Mailing address
416 NW 13TH AVE APT 404, PORTLAND, OR 97209-2938
(503) 973-5156
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD10455
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
257220
—
OR
Enumeration date
03/06/2007
Last updated
07/08/2007
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