| Jeffrey Bloom D.o. Inc, Dba Back Bay Medical | |
|
20311 Sw Acacia St #100 Newport Beach CA 92660-1733 | |
| (949) 263-1242 | |
| (949) 263-1280 |
| Full Name | Jeffrey Bloom D.o. Inc, Dba Back Bay Medical |
|---|---|
| Speciality | Family Medicine - Sports Medicine |
| Location | 20311 Sw Acacia St, Newport Beach, California |
| Authorized Official Name and Position | Jeffrey Howard Bloom (OWNER) |
| Authorized Official Contact | 9492631242 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jeffrey Bloom D.o. Inc, Dba Back Bay Medical 20311 Sw Acacia St #100 Newport Beach CA 92660-1733 Ph: (949) 263-1242 | Jeffrey Bloom D.o. Inc, Dba Back Bay Medical 20311 Sw Acacia St #100 Newport Beach CA 92660-1733 Ph: (949) 263-1242 |
| NPI Number | 1538405220 |
|---|---|
| Provider Enumeration Date | 12/27/2012 |
| Last Update Date | 12/27/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538405220 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | 20A6397 (California) | Primary |
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