Provider Demographics
NPI:1871565556
Name:BLOM, JAMES G (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:G
Last Name:BLOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 94165
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-6465
Mailing Address - Country:US
Mailing Address - Phone:907-212-3186
Mailing Address - Fax:907-212-3665
Practice Address - Street 1:3851 PIPER ST
Practice Address - Street 2:TOWER U, SUITE LL002
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4684
Practice Address - Country:US
Practice Address - Phone:907-212-3186
Practice Address - Fax:907-212-3665
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000366922085R0001X
AK65482085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4045612OtherBLUE CROSS B/S TN INDIV.
TN3045857OtherBLUE CROSS TN GROUP
TN3045857OtherBLUE CROSS TN GROUP
TN3710052Medicare ID - Type UnspecifiedMEDICARE GROUP
TN4045612OtherBLUE CROSS B/S TN INDIV.