Provider Demographics
NPI:1427047034
Name:BOOMGAARD, KENNETH JEROME (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:JEROME
Last Name:BOOMGAARD
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Gender:M
Credentials:MD
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Mailing Address - Street 1:21950 SHELTERING SPRUCE LOOP
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-5402
Mailing Address - Country:US
Mailing Address - Phone:907-688-7826
Mailing Address - Fax:907-580-2308
Practice Address - Street 1:3RD MEDICAL GROUP, ELMENDORF REGIONAL MEDICAL CENTER
Practice Address - Street 2:5955 ZEAMER AVE
Practice Address - City:ELMENDORF AFB
Practice Address - State:AK
Practice Address - Zip Code:99506-3700
Practice Address - Country:US
Practice Address - Phone:907-580-2956
Practice Address - Fax:907-580-2308
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MI4301071073207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine