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1124875059
ELLIS JEREMY BLOOM
PROVIDENCE, RI
NPI
1124875059
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
(Licence: RI LP06198)
Enumeration Date
2024-04-30
Last Update Date
2024-04-30
Business Address
Dr. ELLIS JEREMY BLOOM DO
593 EDDY ST
PROVIDENCE, RI 02903-4923
Phone number: 401-793-2695
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Mailing Address
Dr. ELLIS JEREMY BLOOM DO
593 EDDY ST
PROVIDENCE, RI 02903-4923
Phone number: 401-793-2695
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