Individual
DR. JASON MICHAEL BLOOMBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3100 HENDERSON DR, SUITE 9, CHEYENNE, WY 82001-5846
(307) 426-4673
(307) 426-4674
Mailing address
PO BOX 21004, CHEYENNE, WY 82003-7020
(307) 426-4673
(307) 426-4674
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
11910
NV
207P00000X
Emergency Medicine Physician
22927
NE
207P00000X
Emergency Medicine Physician
6713A
WY
207Q00000X
Family Medicine Physician
11910
NV
207Q00000X
Family Medicine Physician
22927
NE
207Q00000X
Family Medicine Physician
Primary
6713A
WY
207QB0002X
Obesity Medicine (Family Medicine) Physician
6713A
WY
207VX0000X
Obstetrics Physician
11910
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100509999
—
NV
05
—
1005509998
—
NV
05
—
119416000
—
WY
Enumeration date
08/25/2006
Last updated
05/08/2008
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