Healthcare Provider Details

I. General information

NPI: 1699761288
Provider Name (Legal Business Name): HUGH BONNER III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N CLAYTON ST 2ND FLOOR MEDICAL SERVICE BUILDING
WILMINGTON DE
19805-3165
US

IV. Provider business mailing address

701 N CLAYTON ST 2ND FLOOR, MEDICAL SERVICES BUILDING
WILMINGTON DE
19805-3165
US

V. Phone/Fax

Practice location:
  • Phone: 302-575-8040
  • Fax: 302-575-8005
Mailing address:
  • Phone: 302-575-8040
  • Fax: 302-575-8005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC1-0004738
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: