Provider Demographics
NPI:1871932921
Name:BLOOM, ASHLEY ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:ELIZABETH
Last Name:BLOOM
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:325 MAINE STREET
Mailing Address - Street 2:MSO LIBRARY
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044
Mailing Address - Country:US
Mailing Address - Phone:785-505-2988
Mailing Address - Fax:785-505-5228
Practice Address - Street 1:2001 HASKELL AVE STE A
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046-3249
Practice Address - Country:US
Practice Address - Phone:785-505-5420
Practice Address - Fax:785-505-5323
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2023-10-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS0439273207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO028064OtherKAISER COMMERCIAL NUMBER
CO25785036Medicaid