Individual
DR. RAFAEL ANDRES BONILLA VASQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
120 HOSPITAL DR STE 200, LEBANON, MO 65536-9227
(417) 533-6780
Mailing address
120 HOSPITAL DR STE 200, LEBANON, MO 65536-9227
(417) 533-6780
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
2019046474
MO
390200000X
Student in an Organized Health Care Education/Training Program
BP10053644
TX
Other
Enumeration date
06/25/2015
Last updated
06/28/2020
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