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General NPI Number Information
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NPI Number | 1881009132
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Entity Type | Individual
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Provider Name | GEOFFREY BOMMELAERE
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Gender | Male
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Dates
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Enumeration Date | 06/25/2014
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Last Update Date | 05/09/2022
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Provider Practice Location Address
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Address Line | 816 N FOOTE AVE
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-4508
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Country | US
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Telephone | 719-888-1007
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1945
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City | COLORADO SPRINGS
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State | CO
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Zip | 80901-1945
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Country | US
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Telephone | 719-888-1007
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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 | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number | J663
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License Number State |
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