Individual
DR. JONATHAN BOURNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
85 SIERRA PARK RD, MAMMOTH LAKES, CA 93546-0660
(760) 924-4078
(760) 924-4058
Mailing address
PO BOX 660, 85 SIERRA PARK RD, MAMMOTH LAKES, CA 93546-0660
(760) 924-4078
(760) 924-4058
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
G48548
CA
Other
Enumeration date
01/24/2007
Last updated
07/23/2010
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