MEDICARE: PHILLIP LEE BONNEAUX MD

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	207RR0500X	Rheumatology Physician	7366	PR

General Provider Information

NPI Number	:	1629066006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILLIP LEE BONNEAUX MD

Provider Business Mailing Address
First Line	:	PO BOX 21426
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00928-1426
Country	:	US
Telephone Number	:	787-767-4010
Fax Number	:	787-767-4010

Provider Business Practice Location Address
First Line	:	112 CALLE ARZUAGA
Second Line	:	STE 903
City	:	SAN JUAN
State	:	PR
Zip	:	00925-3321
Country	:	US
Telephone Number	:	787-767-4010
Fax Number	:	787-767-4010

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

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	03/27/2014

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