Individual
CRIS H BONTRAGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
220 HOSPITAL DR, JACKSON, AL 36545-2459
(251) 246-9021
(251) 246-1122
Mailing address
112 FOREST AVE, JACKSON, AL 36545-2714
(251) 246-5114
(251) 246-9553
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
DO-902
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
515-29212
BLUE CROSS BLUE SHIELD
AL
Enumeration date
08/13/2006
Last updated
07/08/2007
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