Individual
ERICHSEN R BONOSTRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
1324 LAKELAND HILLS BLVD, LAKELAND, FL 33805-4543
(863) 687-1321
(863) 284-1730
Mailing address
1324 LAKELAND HILLS BLVD, ATTN: MANAGED CARE DEPT., LAKELAND, FL 33805
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
PA9106442
FL
363AS0400X
Surgical Physician Assistant
Primary
PA9106442
FL
Other
Enumeration date
03/02/2012
Last updated
07/07/2017
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