Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 2010006688 | MO |
NPI | 1114147857 |
---|---|
Provider Name | Dr. Anthony James Bonin |
First Address | Shawnee Mission, KS 66201-2747 |
Second Address | Kansas City, MO 64114-4673 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 22/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200665010A | (05) | KS |
44700015 | BCBS (01) |