Individual
ELISA BOMA GARCIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1237 WOODLAND DR, ELIZABETHTOWN, KY 42701-2709
(270) 769-6875
(270) 737-9696
Mailing address
1237 WOODLAND DR, ELIZABETHTOWN, KY 42701-2709
(270) 769-6875
(270) 737-9696
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
20007
KY
2084N0400X
Neurology Physician
Primary
20007
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000050918
ANTHEM BCBS
—
01
—
1050021
PASSPORT
KY
01
—
130012244
RAILROAD MEDICARE
KY
01
—
2432753000
PASSPORT ADVANTAGE
KY
05
—
64200014
—
KY
Enumeration date
05/24/2006
Last updated
06/30/2008
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