Bradley Boman, DO

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

012621 Issued in AZ

Practice address

11851 N 51St Ave Ste E130
Glendale, AZ 85304-2843

Phone

(623) 299-9540

NPI assigned

Mar 21, 2025

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

Medicare fee-for-service enrollment

Enrolled in NV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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

{
    "created_epoch": "1742515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787702400000",
    "number": "1861293243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11851 N 51ST AVE STE E130",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853042843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11851 N 51ST AVE STE E130",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853042843",
            "telephone_number": "623-299-9540"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4801 E McDowell Rd Ste 150",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850087719",
            "country_code": "US",
            "telephone_number": "602-954-3919",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10204 W Happy Valley Pkwy Ste 165",
            "address_purpose": "LOCATION",
            "city": "Peoria",
            "state": "AZ",
            "postal_code": "853832880",
            "country_code": "US",
            "telephone_number": "623-323-6777",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9305 W Thomas Rd Ste 305",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850373366",
            "country_code": "US",
            "telephone_number": "623-478-8000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4515 S McClintock Dr",
            "address_purpose": "LOCATION",
            "city": "Tempe",
            "state": "AZ",
            "postal_code": "852827376",
            "country_code": "US",
            "telephone_number": "602-559-5470",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOMAN",
        "first_name": "BRADLEY",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-03-21",
        "last_updated": "2026-08-26",
        "certification_date": "2026-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "AZ",
            "license": "012621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonathan Bolesta, DMD
• Jenna Bolger, FNP
• Patricia Bolivar, LMSW
• Samantha Anne Bollschweiler
• Mary Ann Bolyog, FNP-C
• Elisa Bomgaars, MD
• Seaton Bonar, DPT
• Marsha Ann Bonnell, FNP
• Kelley M Bonowski, DNP, RN, CPNP-PC
• Adam Bonventre

• All providers in Glendale, AZ
• Dermatology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.