Individual
DR. JEFFREY A BONHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9205 SW BARNES RD, PORTLAND, OR 97225-6603
(503) 797-6356
(503) 292-0346
Mailing address
PO BOX 25180, PORTLAND, OR 97298-0180
(503) 797-6356
(503) 292-0346
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
125059398
IL
2085R0202X
Diagnostic Radiology Physician
183951
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500727621
—
OH
05
—
500727621
—
OR
Enumeration date
07/28/2011
Last updated
10/27/2017
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