Individual
DR. REBECCA A BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1145 S UTICA AVE, STE 110, TULSA, OK 74104-4012
(918) 579-6863
(918) 579-6869
Mailing address
1145 S UTICA AVE, STE 110, TULSA, OK 74104-4013
(918) 579-6863
(918) 579-6869
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
2004015684
MO
207PE0005X
Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
Primary
26032
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200080180A
MEDICAID
OK
05
—
243419306
—
MO
Enumeration date
08/01/2006
Last updated
12/15/2016
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