Individual
ELIZABETH M BLOOMFIELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
855 MONTGOMERY ST, FORT WORTH, TX 76107-2553
(817) 735-2900
(817) 735-2902
Mailing address
PO BOX 99335, FORT WORTH, TX 76199-0335
(817) 735-2900
(817) 735-2902
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA02115
TX
363A00000X
Physician Assistant
PA605
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
196967701
—
TX
01
—
8Y8715
BCBS
TX
01
—
P00680238
RAILROAD MEDICARE
TX
Enumeration date
08/25/2008
Last updated
12/18/2014
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