Individual
DR. TIMOTHY RAY BONINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1309 PONDEROSA DR, SUITE 103, SANDPOINT, ID 83864-8278
(208) 263-9545
(208) 263-9539
Mailing address
1309 PONDEROSA DR, SUITE 103, SANDPOINT, ID 83864-8278
(208) 263-9545
(208) 263-9539
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M8424
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8063566200
—
ID
Enumeration date
02/13/2006
Last updated
02/19/2008
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