Provider Demographics
NPI:1508827163
Name:BOMBERGER, EDWARD II (HS)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:BOMBERGER
Suffix:II
Gender:M
Credentials:HS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 STEDMAN ST
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-6661
Mailing Address - Country:US
Mailing Address - Phone:907-228-0320
Mailing Address - Fax:
Practice Address - Street 1:1300 STEDMAN ST
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-6661
Practice Address - Country:US
Practice Address - Phone:907-228-0320
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other