Provider Demographics
NPI:1326029794
Name:BOMMER, WILLIAM J (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:BOMMER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4860 Y ST
Mailing Address - Street 2:SUITE 0200
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2307
Mailing Address - Country:US
Mailing Address - Phone:916-734-3761
Mailing Address - Fax:916-734-6474
Practice Address - Street 1:4860 Y ST
Practice Address - Street 2:SUITE 0200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-734-3761
Practice Address - Fax:916-734-6474
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2010-01-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG033462207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA45561Medicare UPIN
CA00G334620Medicare PIN