Bloomberg, Gordon R

Bloomberg, Gordon R is an individual health care provider with primary practice located at 1 Childrens Pl Ste 5S30, Saint Louis MO 63110-1002. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatric Allergy/Immunology, which is considered as his primary health care specialty. Bloomberg, Gordon R can be contacted via phone (314) 454-2694.

Contact Information

Primary practice address
1 Childrens Pl Ste 5S30 Saint Louis MO 63110-1002
Phone: (314) 454-2694
Fax: (314) 454-2515
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatric Allergy/Immunology 2080P0201X R2406 Missouri

Profile Details

NPI number 1619993920
LBN Legal business name Bloomberg, Gordon R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 14th, 2006
Last updated Nov 4th, 2015 - about 9 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 1619993920 NPPES
Mississippi MEDICAID 1737758
Mississippi MEDICAID 103810076

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