Doctor Name: | DR. KEITH G BOMAN |
NPI Number: | 1093719338 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | NV4089 |
Business Practice Address: | 601 S Rancho Dr Ste D28 Las Vegas, NV - 891064827 |
Business Phone Number: | 7023830677 |
Business Fax Number: | 7023830688 |
Mailing Address: | 601 S Rancho Dr, Ste D28 LAS VEGAS |
State: | NV |
Postal Code: | 891064827 |
Phone Number: | 7023830677 |
Fax Number: | 7023830688 |
NPI Enumeration Date: | 06/01/2005 |
NPI Last Update Date: | 02/13/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | NV4089 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NV |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |