Individual
MARIO A. BONILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
5026 POOL ROAD, DENISON, TX 75020-4595
(903) 465-3624
(903) 465-3973
Mailing address
5012 S US HIGHWAY 75 STE 300, ATTN BILLING, DENISON, TX 75020-4589
(903) 465-3624
(903) 465-3973
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
F5839
TX
207RC0000X
Cardiovascular Disease Physician
F5839
TX
207RI0011X
Interventional Cardiology Physician
Primary
F5839
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100041710A
—
OK
01
—
12480
MEDICAL LICENSE
OK
05
—
132567208
—
TX
Enumeration date
07/05/2005
Last updated
01/26/2018
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