Dr Douglas Randal Bloom, PHD is a
Clinical Neuropsychologist based in Houston, Texas. Dr Douglas Randal Bloom is licensed to practice in Texas (license number 25782) and his current practice location is
6621 Fannin St, Ccc 1630.00, Houston, Texas. He can be reached at his office (for appointments etc.) via phone at
(832) 822-3700.
NPI number for Dr Douglas Randal Bloom is 1417001116 and his current mailing address is 6621 Fannin St, Ccc 1630.00, Houston, Texas. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1417001116.
Healthcare Provider's Profile
| Full Name | Dr Douglas Randal Bloom |
|---|
| Gender | Male |
|---|
| Speciality | Clinical Neuropsychologist |
|---|
| Location | 6621 Fannin St, Houston, Texas |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1417001116
- Provider Enumeration Date: 01/22/2007
- Last Update Date: 01/10/2023
Medical Identifiers
Medical identifiers for Dr Douglas Randal Bloom such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1417001116 | NPI | - | NPPES |
| 1027542-03 | Medicaid | TX | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 103T00000X | Psychologist | 25782 (Texas) | Secondary |
| 103G00000X | Clinical Neuropsychologist | 25782 (Texas) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Douglas Randal Bloom is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Douglas Randal Bloom, PHD
6621 Fannin St, Ccc 1630.00,
Houston, TX 77030-2303
Ph: (832) 822-3700 | Dr Douglas Randal Bloom, PHD
6621 Fannin St, Ccc 1630.00,
Houston, TX 77030-2303
Ph: (832) 822-3700 |
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