Keith G Boman, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

NV4089 Issued in NV

Practice address

601 S Rancho Dr
Ste. D-28
Las Vegas, NV 89106-4899

Phone

(702) 383-0677

Fax

(702) 383-0688

NPI assigned

Jun 1, 2005

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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  NPD
• Maria Habbi MD

  dba Good Life Primary and Wound Care

  • Family Medicine Physician
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  • NPI 1629687926
  NPD
• Wellhealth Medical Group, PC

  • Obstetrics & Gynecology Physician
  • Las Vegas, NV
  • NPI 1679975361
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1093719338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9260 W. SUNSET RD",
            "address_2": "STE200",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891484903",
            "telephone_number": "702-255-3547",
            "fax_number": "702-921-2419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 S RANCHO DR",
            "address_2": "STE. D-28",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891064899",
            "telephone_number": "702-383-0677",
            "fax_number": "702-383-0688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOMAN",
        "first_name": "KEITH",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-01",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NV",
            "license": "NV4089",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS INDENTIFIER",
            "identifier": "NV 2996",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002002951",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chantell Bolton
• Desean Bolton
• Earlene Bolton
• Jacklynn Bolton
• Eric Boman, DMD
• Scott Boman, MD
• Grace P Bomban, RN
• Jim Bombane
• Simounette Bomely
• Aaron Evens Bomer, PSY. D, LCSW

• Specialist in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Specialist in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.