ELLIS JEREMY BLOOM

PROVIDENCE, RI
NPI1124875059
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy390200000X Student in an Organized Health Care Education/Training Program
(Licence: RI  LP06198)
Enumeration Date2024-04-30
Last Update Date2024-04-30
Business Address
Dr. ELLIS JEREMY BLOOM DO
593 EDDY ST
PROVIDENCE, RI 02903-4923
Phone number: 401-793-2695
Mailing Address
Dr. ELLIS JEREMY BLOOM DO
593 EDDY ST
PROVIDENCE, RI 02903-4923
Phone number: 401-793-2695
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