Provider Demographics
NPI:1689676827
Name:BOMBACH, JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:
Last Name:BOMBACH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 CORPORATE DR
Mailing Address - Street 2:STE 120
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-5192
Mailing Address - Country:US
Mailing Address - Phone:713-773-0803
Mailing Address - Fax:713-271-5422
Practice Address - Street 1:7001 CORPORATE DR
Practice Address - Street 2:STE 120
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-5192
Practice Address - Country:US
Practice Address - Phone:713-773-0803
Practice Address - Fax:713-271-5422
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2853207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX039074201Medicaid
TX039074201Medicaid
TXG77599Medicare UPIN