Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 2691 | AZ |
NPI | 1023089646 |
---|---|
Provider Name | Timothy John Bonatus |
First Address | Flagstaff, AZ 86001 |
Second Address | Flagstaff, AZ 86001-1398 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2006 |
Last Update Date | 17/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
137952 | (05) | AZ |
F38882 | (02) | AZ |