MEDICARE: DR. WILLIAM EARL BONNEY PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA0004919	FL
2	101YM0800X	Mental Health Counselor	MH0001106	FL

General Provider Information

NPI Number	:	1295906089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM EARL BONNEY PHD

Provider Business Mailing Address
First Line	:	1936 W DR MLK JR BLVD
Second Line	:	SUITE 103
City	:	TAMPA
State	:	FL
Zip	:	33607
Country	:	US
Telephone Number	:	813-872-8034
Fax Number	:	813-870-2324

Provider Business Practice Location Address
First Line	:	1936 W DR MARTIN LUTHER KING JR BLVD
Second Line	:	SUITE 103
City	:	TAMPA
State	:	FL
Zip	:	33607
Country	:	US
Telephone Number	:	813-872-8034
Fax Number	:	813-870-2324

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2008
Last Update Date	:	04/25/2008

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