Bomengen, Wade Travis

Bomengen, Wade Travis is an individual health care provider with primary practice located at 120 N C Ave , Thermopolis WY 82443-2410. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Bomengen, Wade Travis can be contacted via phone (307) 864-5534.

Contact Information

Primary practice address
120 N C Ave Thermopolis WY 82443-2410
Phone: (307) 864-5534
Fax: (307) 864-9470
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 5946AWY Wyoming

Profile Details

NPI number 1710959168
LBN Legal business name Bomengen, Wade Travis
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 1st, 2006
Last updated Mar 7th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1710959168 NPPES
Wyoming Other 5946AWY WY MEDICAL LICENSE #
Wyoming MEDICAID 113009900 WY MEDICAL LICENSE #
Wyoming Other 613WB97 WY MEDICAL LICENSE #

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