Healthcare Provider Details

I. General information

NPI: 1841301074
Provider Name (Legal Business Name): JAMES R. BONNER, MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 RESERVOIR AVE SUITE 205
CRANSTON RI
02920-6068
US

IV. Provider business mailing address

1150 RESERVOIR AVE SUITE 205
CRANSTON RI
02920-6068
US

V. Phone/Fax

Practice location:
  • Phone: 401-943-9222
  • Fax: 401-943-9290
Mailing address:
  • Phone: 401-943-9222
  • Fax: 401-943-9290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD08084
License Number StateRI

VIII. Authorized Official

Name: DR. JAMES ROY BONNER
Title or Position: OWNER
Credential: M.D.
Phone: 401-943-9222