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General NPI Number Information
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NPI Number | 1437195419
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Entity Type | Organization
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Legal Business Name | BONHAM INTERNAL MEDICINE, P.A.
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 509 N CENTER ST
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City | BONHAM
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State | TX
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Zip | 75418-3705
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Country | US
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Telephone | 903-640-8300
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Fax | 903-361-0714
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Provider Business Mailing Address
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Address Line | 509 N CENTER ST
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City | BONHAM
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State | TX
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Zip | 75418-3705
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Country | US
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Telephone | 903-640-8300
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Fax | 903-361-0714
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Authorized Official
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Title or Position | OWNER PHYSICIAN
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Name | KAISS ABOUBAKER
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Credential | M.D.
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Telephone | 903-640-8300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | L8242
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License Number State | TX
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