1619959335 NPI number — ALEXANDER C BONNER DPM

Table of content: ALEXANDER C BONNER DPM (NPI 1619959335)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619959335 NPI number — ALEXANDER C BONNER DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BONNER
Provider First Name:
ALEXANDER
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619959335
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1150 CAMPO SANO AVE
Provider Second Line Business Mailing Address:
SUITE 410
Provider Business Mailing Address City Name:
CORAL GABLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33146-1174
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-669-3339
Provider Business Mailing Address Fax Number:
305-233-5220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1150 CAMPO SANO AVE
Provider Second Line Business Practice Location Address:
SUITE 410
Provider Business Practice Location Address City Name:
CORAL GABLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33146-1174
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-669-3339
Provider Business Practice Location Address Fax Number:
305-233-5220
Provider Enumeration Date:
11/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  PO626 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 406480210 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 650028975 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 029603100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 650025975 . This is a "TAX ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 16002 . This is a "SFCN/PSN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 029603100 . This is a "SFCN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 650028975 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 650028975 . This is a "HEALTHOPTIONS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 87359 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 212695 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 650028975 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com