Individual
MATTHEW J BONANNO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1295 JACARANDA BLVD, VENICE, FL 34292-4522
(941) 484-1510
(941) 484-1071
Mailing address
15051 S TAMIAMI TRL, SUITE 203, FORT MYERS, FL 33908-5182
(239) 437-8810
(239) 313-2555
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
ME88794
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ME88794
FL MEDICAL LICENSE
FL
Enumeration date
09/14/2006
Last updated
06/01/2016
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