Healthcare Provider Details

I. General information

NPI: 1336674936
Provider Name (Legal Business Name): ERIN BOMBERG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2017
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

942 OAK STREET
STEAMBOAT SPRINGS CO
80487
US

IV. Provider business mailing address

PO BOX 881029
STEAMBOAT SPRINGS CO
80488-1029
US

V. Phone/Fax

Practice location:
  • Phone: 970-879-9362
  • Fax:
Mailing address:
  • Phone: 970-846-8035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberDR.0063852
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: