Individual
GEORGE J BONNEVIE III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
680 CENTRE ST, RADIOLOGY DEPARTMENT, BROCKTON, MA 02302-3308
(508) 941-7150
(508) 941-6104
Mailing address
680 CENTRE ST, RADIOLOGY DEPARTMENT, BROCKTON, MA 02302-3308
(508) 941-7150
(508) 941-6104
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
217144
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2005883
—
MA
Enumeration date
05/18/2006
Last updated
10/02/2012
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