Active NPI
Evan Bloom, DO
- Anesthesiology Physician
- Deland, FL
National Provider Identifier
1457397564
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- OS8787
- Practice address
- 701 W Plymouth Ave
Deland, FL 32720-3236 - Phone
- (407) 667-0444
- Fax
- (407) 667-4338
- NPI assigned
- Jun 20, 2006
- Last updated
- Feb 15, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | OS8787 | FL | Primary |
Addresses
Primary practice location
701 W Plymouth Ave
Deland, FL 32720-3236
Mailing address
291 Southhall LN
Suite 201
Maitland, FL 32751-7274
Phone (407) 667-0444
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 71698 | Other | FL | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150761600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1203033600000",
"number": "1457397564",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "291 SOUTHHALL LN",
"address_2": "SUITE 201",
"city": "MAITLAND",
"state": "FL",
"postal_code": "327517274",
"telephone_number": "407-667-0444",
"fax_number": "407-667-4338"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "701 W PLYMOUTH AVE",
"city": "DELAND",
"state": "FL",
"postal_code": "327203236",
"telephone_number": "407-667-0444",
"fax_number": "407-667-4338"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLOOM",
"first_name": "EVAN",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-20",
"last_updated": "2008-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "FL",
"license": "OS8787",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "71698",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Deland, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.