Healthcare Provider Details

I. General information

NPI: 1053334417
Provider Name (Legal Business Name): STEVEN H BONNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 04/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 COLUMBIANA ROAD SUITE 4000
BIRMINGHAM AL
35216-2158
US

IV. Provider business mailing address

2090 COLUMBIANA ROAD SUITE 4000
BIRMINGHAM AL
35216-2158
US

V. Phone/Fax

Practice location:
  • Phone: 205-536-8400
  • Fax: 205-521-7078
Mailing address:
  • Phone: 205-536-8400
  • Fax: 205-521-7078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number22502
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number22502
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD.22502
License Number StateAL
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number68484
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35.123406
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD-41751
License Number StateIA
# 7
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101256396
License Number StateVA
# 8
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2014025047
License Number StateMO
# 9
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number15452
License Number StateNV
# 10
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD2014-0705
License Number StateNM
# 11
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME-121239
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: