Individual
MARK W BONNER
Active
Individual
MARK W BONNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
057047
GA
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
057047
GA
207N00000X
Dermatology Physician
Primary
057047
GA
207ND0900X
Dermatopathology Physician
057047
GA
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
057047
GA
207NP0225X
Pediatric Dermatology Physician
057047
GA
207NS0135X
Procedural Dermatology Physician
057047
GA
208D00000X
General Practice Physician
057047
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
413577315A
—
GA
01
—
DC4061
RAILROAD MEDICARE
GA
01
—
P00258031
RAILROAD MEDICARE
GA
Enumeration date
02/16/2006
Last updated
05/03/2024
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