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General NPI Number Information
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NPI Number | 1780782839
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Entity Type | Individual
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Provider Name | SCOTT B BOMGAARS M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 04/13/2011
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Provider Practice Location Address
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Address Line | 201 RIDGE ST SUITE 105
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-4643
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Country | US
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Telephone | 712-396-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 201 RIDGE ST SUITE 105
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-4643
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Country | US
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Telephone | 712-396-5437
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 28603
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License Number State | IA
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