Individual
ROGER D BONHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
500 N KEENE ST, SUITE 101, COLUMBIA, MO 65201-8104
(573) 449-3846
(573) 449-3706
Mailing address
500 N KEENE ST, SUITE 101, COLUMBIA, MO 65201-8105
(573) 449-3846
(573) 449-3706
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
R6F35
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180012949
RAILROAD MEDICARE
MO
05
—
202256202
—
MO
Enumeration date
07/19/2005
Last updated
08/19/2011
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