MEDICARE: BRUCE A. BONSACK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD00035570	WA

General Provider Information

NPI Number	:	1225113566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE A. BONSACK MD

Provider Business Mailing Address
First Line	:	PO BOX 84026
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98124-8426
Country	:	US
Telephone Number	:	206-320-3399
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 CALIFORNIA AVE SW
Second Line	:	SUITE 300
City	:	SEATTLE
State	:	WA
Zip	:	98116-3307
Country	:	US
Telephone Number	:	206-320-3399
Fax Number	:	206-320-5506

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	02/06/2009

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