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NPI Code Detail

MEDICARE: MARIO A. BONILLA M.D

MEDICARE: MARIO A. BONILLA M.D
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
1207R00000XInternal Medicine PhysicianF5839TX
2207RC0000XCardiovascular Disease PhysicianF5839TX
3207RI0011XInterventional Cardiology PhysicianF5839TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
112480OTHEROKMEDICAL LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1609873736
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIO A. BONILLA M.D
Provider Business Mailing Address
First Line : 5012 S US HIGHWAY 75 STE 300
Second Line : ATTN BILLING
City : DENISON
State : TX
Zip : 75020-4589
Country : US
Telephone Number : 903-465-3624
Fax Number : 903-465-3973
Provider Business Practice Location Address
First Line : 5026 POOL ROAD
Second Line :
City : DENISON
State : TX
Zip : 75020-4595
Country : US
Telephone Number : 903-465-3624
Fax Number : 903-465-3973
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2005
Last Update Date : 01/26/2018

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Directions to “ MARIO A. BONILLA M.D” Practice Location

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