Individual
JACK E BONHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1600 ALBANY ST, BEECH GROVE, IN 46107-1541
(317) 802-3151
(317) 870-0499
Mailing address
PO BOX 7112, DPT 31, INDIANAPOLIS, IN 46207-7112
(317) 802-3151
(317) 870-0499
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10001193A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300016938
—
IN
Enumeration date
07/16/2010
Last updated
06/25/2021
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