Individual
DR. JEFFREY BONNEVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMSC MS LPO
Contact information
Practice address
150 S HUNTINGTON AVE, BOSTON, MA 02130-4817
(857) 364-6962
Mailing address
150 S HUNTINGTON AVE, BOSTON, MA 02130-4817
(857) 364-6962
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
OH000281
PA
224P00000X
Prosthetist
211.000165
IL
224P00000X
Prosthetist
PO000194
PA
Other
Enumeration date
03/21/2017
Last updated
03/21/2017
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