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General NPI Number Information
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NPI Number | 1023902749
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Entity Type | Individual
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Provider Name | JOSHUA BOMMELJE PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/06/2025
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 1805 27TH ST
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City | PORTSMOUTH
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State | OH
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Zip | 45662-2640
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Country | US
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Telephone | 740-356-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 6276 SEDGE LN
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City | HILLIARD
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State | OH
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Zip | 43026-2109
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.009481RX
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License Number State | OH
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