Healthcare Provider Details

I. General information

NPI: 1033570965
Provider Name (Legal Business Name): PAUL ALEXANDER BONNER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2016
Last Update Date: 12/15/2021
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 DELAWARE AVE
MARION OH
43302-6416
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 403-837-9507
  • Fax:
Mailing address:
  • Phone: 419-520-2495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number34.015324
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: