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NPI Code Detail

MEDICARE: ELISA BOMGAARS MD

MEDICARE: ELISA BOMGAARS MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RH0003XHematology & Oncology Physician47975AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841220225
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELISA BOMGAARS MD
Provider Business Mailing Address
First Line : PO BOX 6423
Second Line :
City : CHANDLER
State : AZ
Zip : 85246-6423
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5810 W BEVERLY LN
Second Line :
City : GLENDALE
State : AZ
Zip : 85306-1800
Country : US
Telephone Number : 623-312-3000
Fax Number : 623-312-3060
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2006
Last Update Date : 08/29/2019

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