Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 19045 | NC |
NPI | 1013013226 |
---|---|
Provider Name | Dr. Irvin R Bonnin |
First Address | Gastonia, NC 28052-6430 |
Second Address | Gastonia, NC 28052-6430 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 10/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
19045 | LISCENCE # (01) | NC |
8916437 | (05) | NC |