Healthcare Provider Details

I. General information

NPI: 1124137013
Provider Name (Legal Business Name): ROBERT BRYAN BOMBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 12TH ST
BUTNER NC
27509-1626
US

IV. Provider business mailing address

5616 COMMUNITY DR
DURHAM NC
27705-8122
US

V. Phone/Fax

Practice location:
  • Phone: 919-575-7302
  • Fax:
Mailing address:
  • Phone: 919-929-2691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number18246
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: