Organization
WILLIAM A BLOOM MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM A BLOOM MD (MANAGER MEMBER)
(985) 643-8561
Entity
Organization
Contact information
Practice address
105 MEDICAL CENTER DRIVE, SUITE 305, SLIDELL, LA 70461-5539
(985) 643-8561
(985) 649-7573
Mailing address
654 MARILYN DRIVE, MANDEVILLE, LA 70448-4730
(985) 626-4108
(985) 649-7573
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1365718
—
LA
01
—
24377
BLUE CROSS BLUE SHIELD
LA
Enumeration date
06/06/2006
Last updated
08/22/2020
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