Organization
JOHANNES V. BLOM, MD, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHANNES V. BLOM MD (PRESIDENT)
(954) 964-6114
Entity
Organization
Contact information
Practice address
3702 WASHINGTON ST, SUITE 202, HOLLYWOOD, FL 33021-8282
(954) 964-6114
(954) 962-1994
Mailing address
3702 WASHINGTON ST, SUITE 202, HOLLYWOOD, FL 33021-8282
(954) 964-6114
(954) 962-1994
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME94285
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1184654519
PROVIDER NPI
FL
05
—
275038400
—
FL
Enumeration date
04/27/2009
Last updated
12/15/2009
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