Provider Demographics
NPI:1437262581
Name:BOMBERG, BRYAN C (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:C
Last Name:BOMBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 MARKETPLACE PLZ STE 200
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-1841
Mailing Address - Country:US
Mailing Address - Phone:970-879-6663
Mailing Address - Fax:970-871-1234
Practice Address - Street 1:705 MARKETPLACE PLZ
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-1838
Practice Address - Country:US
Practice Address - Phone:970-879-6663
Practice Address - Fax:970-871-1234
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2021-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO29881207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01298819Medicaid
COBO95948OtherCO BCBS
COC95948Medicare PIN
COE68269Medicare UPIN
CO01298819Medicaid
CO200021093Medicare PIN