Johannes V. Blom, MD, PA

Primary specialty

SpecialistTaxonomy code 174400000X

License

ME94285 Issued in FL

Legal business name

JOHANNES V. BLOM, MD, PA

Practice address

3702 Washington St
Suite 202
Hollywood, FL 33021-8282

Phone

(954) 964-6114

Fax

(954) 962-1994

NPI assigned

Apr 27, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Johannes V. Blom, MD

Title

President

Phone

(954) 964-6114

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1240790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260835200000",
    "number": "1558505149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3702 WASHINGTON ST",
            "address_2": "SUITE 202",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330218282",
            "telephone_number": "954-964-6114",
            "fax_number": "954-962-1994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3702 WASHINGTON ST",
            "address_2": "SUITE 202",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330218282",
            "telephone_number": "954-964-6114",
            "fax_number": "954-962-1994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHANNES V. BLOM, MD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-27",
        "last_updated": "2009-12-15",
        "status": "A",
        "authorized_official_last_name": "BLOM",
        "authorized_official_first_name": "JOHANNES",
        "authorized_official_middle_name": "V.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "954-964-6114",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME94285",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NPI",
            "identifier": "1184654519",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "275038400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.