Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Bloom Primary Tx II, PA

Organization Internal Medicine Physician · NPI 1689598377

Bloom Primary Tx II, PA is an Internal Medicine Physician in Southlake, Texas. Registered with an NPI since 2026.

In the registry since
2026
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

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Practice location Address checks out

545 S Nolen Dr Ste 300
Southlake, TX 76092-9176
Phone: (303) 993-1330
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X

Record details

NPI number1689598377
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Debra Moon Wadelton — Authorized Official · (720) 923-1250
NPI enumeratedAugust 6, 2026
Last updated in NPPESAugust 6, 2026
Certification dateAugust 6, 2026
Mailing address12600 W Colfax Ave Ste 200, Lakewood, CO 80215-3733

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