Organization
ROGER D. BONHAM M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY CUNDIFF (GENERAL MANAGER)
(573) 449-3846
Entity
Organization
Contact information
Practice address
500 N KEENE ST, SUITE 101, COLUMBIA, MO 65201-8105
(573) 449-3846
(573) 449-3706
Mailing address
500 N KEENE ST, SUITE 101, COLUMBIA, MO 65201-8105
(573) 449-3846
(573) 449-3846
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
R6F35
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202256202
—
MO
01
—
DH1046
RAILROAD MEDICARE
MO
Enumeration date
03/09/2007
Last updated
09/14/2009
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