Bloemendal, Lee Charles

Bloemendal, Lee Charles is an individual health care provider with primary practice located at 1325 Pennsylvania Ave Suite 720, Fort Worth TX 76104-2144. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Bloemendal, Lee Charles can be contacted via phone (817) 336-7305.

Contact Information

Primary practice address
1325 Pennsylvania Ave Suite 720 Fort Worth TX 76104-2144
Phone: (817) 336-7305
Fax: (817) 336-8941
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X D5919 Texas

Profile Details

NPI number 1952326787
LBN Legal business name Bloemendal, Lee Charles
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 13th, 2006
Last updated Oct 4th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1952326787 NPPES
Other 020054578 RAILROAD MEDICARE
MEDICAID 032314902 RAILROAD MEDICARE

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