Provider Demographics
NPI:1780755439
Name:BOMANN, JOHN SCOTT (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SCOTT
Last Name:BOMANN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 MINE HILL RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-2071
Mailing Address - Country:US
Mailing Address - Phone:203-292-5266
Mailing Address - Fax:
Practice Address - Street 1:1235 MINE HILL RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-2071
Practice Address - Country:US
Practice Address - Phone:203-292-5266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215670207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine