Individual
DR. LEROY WOMBOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
122 E MAIN ST, PAYSON, AZ 85541
(928) 596-4600
(928) 596-4620
Mailing address
122 E MAIN ST, PAYSON, AZ 85541-5574
(928) 596-4600
(928) 596-4620
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
005165
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
349989
—
AZ
Enumeration date
03/07/2006
Last updated
06/08/2018
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