Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 5138 | TX |
NPI | 1417957846 |
---|---|
Provider Name | Dr. Alan Ray Bonebrake |
First Address | Plano, TX 75074-6895 |
Second Address | Plano, TX 75074-6895 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 23/12/2011 |