Individual
DR. TIMOTHY ALAN BONSACK
Active
Individual
DR. TIMOTHY ALAN BONSACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
ME68441
FL
2085R0202X
Diagnostic Radiology Physician
Primary
ME68441
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300063105
RR MCR
FL
05
—
378134800
—
FL
Enumeration date
02/21/2006
Last updated
04/01/2010
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