Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | PO3971 | FL |
NPI | 1053795237 |
---|---|
Provider Name | Dr. Jeremy Bonjorno |
First Address | Venice, FL 34285-3524 |
Second Address | Venice, FL 34285 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2015 |
Last Update Date | 13/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A3B0A | BCBS (01) | FL |