Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | L6295 | TX |
NPI | 1699787572 |
---|---|
Provider Name | William F Bonnell JR. |
First Address | Fort Worth, TX 76199-0213 |
Second Address | Fort Worth, TX 76104-2733 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2006 |
Last Update Date | 13/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00L42V | MEDICARE GROUP (01) | TX |
137283112 | MEDICAID GROUP (01) | TX |
137283113 | CSHCN GROUP (01) | TX |
161783905 | CSHCN (01) | TX |
161783906 | (05) | TX |
1669442042 | GRP NPI NUMBER (01) | |
H95826 | (02) |