Healthcare Provider Details

I. General information

NPI: 1053678151
Provider Name (Legal Business Name): JONATHAN PAUL BONNET M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 12/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4830 NW 43RD ST M194
GAINESVILLE FL
32606-4401
US

IV. Provider business mailing address

4830 NW 43RD ST APT M194
GAINESVILLE FL
32606-4408
US

V. Phone/Fax

Practice location:
  • Phone: 937-269-4104
  • Fax:
Mailing address:
  • Phone: 937-269-4104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberME125797
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: