Individual
DR. MARK DOUGLAS BONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
SANTA CLARA HEALTH CENTER, RR 5 BOX 446, ESPANOLA, NM 87532-8908
(505) 753-5039
Mailing address
RR 5 BOX 446, SANTA CLARA PUEBLO HEALTH CENTER, ESPANOLA, NM 87532-8908
(505) 753-9421
(505) 753-5039
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
85-163
NM
207R00000X
Internal Medicine Physician
85-163
NM
Other
Enumeration date
12/16/2005
Last updated
11/19/2007
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