Provider Demographics
NPI:1801977749
Name:BOMBRYS, ANNETTE (DO)
Entity type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:
Last Name:BOMBRYS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3533 SOUTHERN BLVD STE 3750
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1268
Mailing Address - Country:US
Mailing Address - Phone:937-610-3220
Mailing Address - Fax:937-610-3225
Practice Address - Street 1:3533 SOUTHERN BLVD STE 3750
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1268
Practice Address - Country:US
Practice Address - Phone:937-610-3220
Practice Address - Fax:937-610-3225
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-008640207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2992490Medicaid