Individual
DR. JORDAN BRADLEY BONOMO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
231 ALBERT SABIN WAY, ML 0769, CINCINNATI, OH 45267-0769
(513) 558-5281
(513) 558-5791
Mailing address
2830 VICTORY PKWY, CENTRAL CREDENTIALING DEPARTMENT ML0806, CINCINNATI, OH 45206-1785
(513) 245-3667
(513) 475-7259
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
35.087498
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200837820
—
IN
05
—
2737882
—
OH
05
—
7100042390
—
KY
Enumeration date
07/26/2006
Last updated
01/29/2010
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