Individual
DR. WADE TRAVIS BOMENGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
120 N C AVE, THERMOPOLIS, WY 82443-2410
(307) 864-5534
(307) 864-9470
Mailing address
120 N C AVE, THERMOPOLIS, WY 82443-2410
(307) 864-5534
(307) 864-9470
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5946AWY
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113009900
—
WY
01
—
5946AWY
WY MEDICAL LICENSE #
WY
01
—
613WB97
WY CONTROLLED SUBSTANCE #
WY
Enumeration date
02/01/2006
Last updated
03/07/2023
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