Provider Demographics
NPI:1487760732
Name:BLOOM, MARTIN GLENN (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:GLENN
Last Name:BLOOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 S FEDERAL HWY
Mailing Address - Street 2:SUITE J
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-3222
Mailing Address - Country:US
Mailing Address - Phone:561-257-2511
Mailing Address - Fax:561-257-5051
Practice Address - Street 1:3100 S FEDERAL HWY
Practice Address - Street 2:SUITE J
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-3222
Practice Address - Country:US
Practice Address - Phone:561-257-2511
Practice Address - Fax:561-257-5051
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME27887207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL50843AMedicare ID - Type Unspecified
D55860Medicare UPIN