Individual
HERBERT L BONKOVSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 MEDICAL CENTER DR, WINSTON SALEM, NC 27157-0001
(336) 713-7306
Mailing address
2214 CUMBERLAND AVE, CHARLOTTE, NC 28203-6009
(704) 307-4956
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
037512
CT
207RG0100X
Gastroenterology Physician
Primary
2008-00082
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1821093592
—
NC
05
—
5909228
—
NC
05
—
N0008A
—
SC
Enumeration date
06/17/2005
Last updated
12/10/2014
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