Individual
ANTHONY J BONITATIBUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1001 NOBLE ST STE 1, FAIRBANKS, AK 99701-4991
(907) 458-2635
Mailing address
1001 NOBLE ST STE 1, FAIRBANKS, AK 99701-4991
(907) 458-2635
(907) 459-3541
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
166113
AK
207K00000X
Allergy & Immunology Physician
45670
MN
207K00000X
Allergy & Immunology Physician
51624
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003121233A
—
GA
05
—
1714176
—
AK
05
—
550638700
—
MN
Enumeration date
07/06/2006
Last updated
02/03/2021
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