Organization
RICHARD R. BLOOM M.D. LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD RICHARDO BLOOM M.D. (CEO)
(706) 576-4474
Entity
Organization
Contact information
Practice address
1900 5TH AVE, COLUMBUS, GA 31904-8916
(706) 576-4474
(706) 576-5940
Mailing address
PO BOX 7811, COLUMBUS, GA 31908-7811
(706) 576-4474
(706) 576-5940
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00476693
—
GA
05
—
312282
—
GA
Enumeration date
10/24/2006
Last updated
04/03/2008
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