1831150408 NPI number — MR. ERNST BONTEMPS MD

Table of content: MR. ERNST BONTEMPS MD (NPI 1831150408)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831150408 NPI number — MR. ERNST BONTEMPS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BONTEMPS
Provider First Name:
ERNST
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1831150408
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3001 EXECUTIVE DR STE 130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEARWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33762-5323
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-349-0005
Provider Business Mailing Address Fax Number:
727-541-6558

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7017 CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-384-2016
Provider Business Practice Location Address Fax Number:
727-343-3791
Provider Enumeration Date:
03/31/2006

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: 207RG0100X , with the licence number:  ME83742 , 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: 09008 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 100016262 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 264350200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: N217005 . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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