Provider Demographics
NPI:1295824522
Name:BOMPHRAY, GARY NORMAN (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:NORMAN
Last Name:BOMPHRAY
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 1:211 SHARPE STREET
Mailing Address - Street 2:
Mailing Address - City:ESSEXVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48732
Mailing Address - Country:US
Mailing Address - Phone:989-895-8950
Mailing Address - Fax:
Practice Address - Street 1:406 7TH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-5849
Practice Address - Country:US
Practice Address - Phone:989-615-1469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301043402207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine