Individual
PAUL M BOMMERSBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
800 E 21ST ST, SIOUX FALLS, SD 57105-1016
(605) 322-2754
(605) 322-2727
Mailing address
800 E 21ST ST, PAT FINANCIAL SERV., SIOUX FALLS, SD 57105-1016
(605) 322-2754
(605) 322-2727
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R025403
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005230
BLUE CROSS OF SD
SD
01
—
013K4BO
MN BLUE CROSS BS
MN
05
—
1538736
—
IA
05
—
2538736
—
IA
05
—
350443300
—
MN
05
—
46022474348
—
NE
01
—
4995505
WELLMARK
SD
05
—
5751464
—
SD
05
—
5751466
—
SD
01
—
R025403
DAKOTACARE
SD
Enumeration date
09/19/2005
Last updated
08/20/2010
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