Individual
DR. EDWIN R BONILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
403 W 8TH ST, DERIDDER, LA 70634-5507
(337) 463-8977
(337) 462-3093
Mailing address
901 BIRCH DR, DERIDDER, LA 70634-5308
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
08674
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1913324
—
LA
Enumeration date
08/31/2006
Last updated
04/08/2015
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