Individual
ALBERT J BONEBRAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1001 E PRIMROSE ST, SPRINGFIELD, MO 65807-5155
(417) 875-3000
(417) 875-3450
Mailing address
PO BOX 9007, SPRINGFIELD, MO 65808-9007
(417) 875-3000
Taxonomy
Speciality
Code
Description
License number
State
207VX0201X
Gynecologic Oncology Physician
Primary
35473
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18053
BLUE CROSS/BLUE SHIELD
—
05
—
200249522
—
MO
Enumeration date
06/12/2006
Last updated
07/03/2012
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