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General NPI Number Information
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NPI Number | 1689862997
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Entity Type | Organization
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Legal Business Name | SHAWN A. BONNER D.O., INC
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Dates
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Enumeration Date | 10/11/2007
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Last Update Date | 02/08/2011
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Provider Practice Location Address
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Address Line | 2447 MAPLE AVE
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City | ZANESVILLE
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State | OH
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Zip | 43701-1831
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Country | US
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Telephone | 740-454-4800
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Fax | 740-454-4838
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Provider Business Mailing Address
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Address Line | 2447 MAPLE AVE
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City | ZANESVILLE
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State | OH
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Zip | 43701-1831
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Country | US
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Telephone | 740-454-4800
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Fax | 740-454-4838
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Authorized Official
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Title or Position | PHYSICIAN/PRESIDENT
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Name | DR. SHAWN ANDREW BONNER
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Credential | D.O.
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Telephone | 740-454-4800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 34-007216-B
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License Number State | OH
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