Individual
DR. SALLY A. BOMAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2016 S MAIN ST, MARYVILLE, MO 64468-2655
(660) 562-2525
(660) 562-4303
Mailing address
114 EAST SOUTH HILLS DR., MARYVILLE, MO 64468-2659
(660) 562-2525
(660) 562-7993
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
105981
MO
207Q00000X
Family Medicine Physician
31578
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0984591
—
IA
05
—
208078311
—
MO
Enumeration date
06/01/2005
Last updated
11/09/2012
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