Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 14653 | DC |
NPI | 1063446573 |
---|---|
Provider Name | Bruce G Bonn |
First Address | Washington, DC 20037-1445 |
Second Address | Washington, DC 20037-1445 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3060-0001 | BLUECROSS BLUESHIELD (01) | DC |
B94319 | (02) | DC |