Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | A104449 | CA |
N | 207P00000X | Emergency Physician | AJ4147357 | MD |
NPI | 1013053669 |
---|---|
Provider Name | Benjamin J. Bonnes |
First Address | Oakland, CA 94611-5641 |
Second Address | Oakland, CA 94611-5641 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 13/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T4748 | JOHNS HOPKINS HOSPITAL ID (01) | MD |