Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 06161 | MS |
NPI | 1033123716 |
---|---|
Provider Name | David W Bomboy |
First Address | Hattiesburg, MS 39401-7246 |
Second Address | Hattiesburg, MS 39401-7246 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 23/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00112872 | (05) | MS |
200027909 | RAILROAD MEDICARE (01) | |
640507572IS | AMERICAN ADMIN GROUP (01) | MS |
B29924 | (02) |