Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | MD019375-E | PA |
NPI | 1194731547 |
---|---|
Provider Name | Dennis James Bonner |
First Address | Levittown, PA 19056-2107 |
Second Address | Levittown, PA 19056-2107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 17/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000183 | BLUE SHIELD HIGHMARK (01) | PA |
0023032000 | HMO (01) | PA |
B95787 | (02) |