Healthcare Provider Details

I. General information

NPI: 1134458441
Provider Name (Legal Business Name): BONNIE PARKER MCTYRE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 10/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 PREMIER DRIVE STE 203
HIGH POINT NC
27265-8356
US

IV. Provider business mailing address

4515 PREMIER DRIVE STE 203
HIGH POINT NC
27265-8356
US

V. Phone/Fax

Practice location:
  • Phone: 336-802-2200
  • Fax: 336-802-2201
Mailing address:
  • Phone: 336-802-2200
  • Fax: 336-802-2201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number192856
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: