Provider Demographics
NPI:1730151853
Name:BLOOMQUIST, ERICA VICTORIA (MD, MPH)
Entity type:Individual
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First Name:ERICA
Middle Name:VICTORIA
Last Name:BLOOMQUIST
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Gender:F
Credentials:MD, MPH
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Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:MPG DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5681
Mailing Address - Fax:954-985-7074
Practice Address - Street 1:1150 N 35TH AVE
Practice Address - Street 2:SUITE 205A
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5424
Practice Address - Country:US
Practice Address - Phone:954-265-5846
Practice Address - Fax:954-985-2451
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2024-06-20
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Provider Licenses
StateLicense IDTaxonomies
FLME1192462086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL011820100Medicaid
FLHU529ZOtherMEDICARE PTAN