Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 2012-00894 | NC |
N | 111NI0900X | Internist | 2012-00894 | NC |
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 35589 | SC |
N | 207RC0000X | Internist - Cardiovascular Disease | 35589 | SC |
NPI | 1144457086 |
---|---|
Provider Name | Eric Le-Minh-Duc Bonno |
First Address | Greenville, SC 29601-2842 |
Second Address | Greenville, SC 29605-4630 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2009 |
Last Update Date | 06/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
355895 | (05) | SC |
SC90457951 | (02) | SC |